Online Email Consultation: In order for Dr. Li to have a clear picture of your situation, please fill out the short questionnaire below. If possible, attach photo(s) of the affected area at the bottom of this form. After you have submitted the form, you will receive a confirmation that your form was processed. The form will be sent directly to Dr. Li for her review. Please allow 1-2 business days for a response.**
Patient Name (if different)
Your Email Address: (Required)
Verify Email Address: (Required)
How long have you had Shingles?
Do you have chickenpox in your young age?
Which part of your body does the Shingles affect?
What symptom of Shingles do you experience?
How Do you rate your pain?
What type of treatment have you used before?
How did you hear about us?
(such as Google, WebMD, etc..)
You may attach (optional) Pictures to help Dr. Li understand the situation: