In an attempt to reduce your exposure to, and the spread of, COVID-19 we are trying to limit the number of patients seen in our office and insure safe personal distancing. At the same time, we recognize the need to evaluate all patients seeking an opinion regarding a skin problem.
You can either email this back to us or send us a synopsis. Photographs will be helpful and be assured that our privacy will be respected. Ideally, photos should be taken under natural daylight.
Your name:
Your age and occupation:
A brief description of the skin problem. Please send us photos, if appropriate. Let us know how long you’ve had this problem, whether it has been treated by another physician, and with what medications.
General Information: In a paragraph or two, let me know:
- What other skin problems you may have had, whether any skin problems runs in your family, what allergies do you have, specifically to drugs and what the reaction was.
- Please let me know what other problems you have been treated for by physicians or other health care providers.
- Please let me know all medications you are taking. This includes pills, liquids, injectable medications, over-the-counter medications. Include all creams and other topical medications.
- Please let me know any other concerns you may have.
Do you have a personal or family history of asthma, hay fever, eczema, or hives?
Do you have a personal history of skin cancer? If yes, what type.
Do you have a family history of skin cancer and if so what type?
Are there any particular stressors in your life that we should know about?
For Women Only. Are you pregnant or breast-feeding?
If it’s appropriate, please let me know if you are using birth control pills or hormones.
In a brief paragraph let me know if you have any other specific concerns and what comments you would like to make.
It is said: "If the physician listens long enough, the patient will tell her/him what the diagnosis is.”
Ideally, you can email the answers to me at:
Dr. Eloern’s personal email: djelpern@gmail.com
Office email: elpern.office@gmail.com
Office Fax: 413–458–4224.
Thank you!