Physician 360 Telehealth Consult
As many patients have used this service in the past, we can refer you to a consult with Physician 360 who has helped patients who may not have a provider but would like to speak to one via telehealth. Please fill out the information below and you will receive next steps via email. To make the process easier, the email their team sends you for next steps will also be included in the thank you page/email when you submit this form.
Patient's Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
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Email
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Please double check and ensure this is accurate as you will get an email from Physician 360 at this email address.
Purpose
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Anemia
Birth Control
Coronavirus
Ear Infection
Erectile Dysfunction
Flu
Hair Loss & Regrowth
High Cholesterol
Pain Management
Strep Throat
UTI
Weight Loss
Other
Anything else we should know when we connect you to Physician 360
Signature: By signing below I give Skippack Pharmacy consent to share information from the Interest Form I filled out & data above with the Physician 360 provider's team. Physician 360 providers will utilize this information along with information I input when creating a profile/making a payment on the Physician 360 system in the next steps. In the event I need any support for Physician 360, I will reach out to their team directly at support@myphysician360.com or by calling them: 360-861-6199.
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