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 many years have you had Melasma?
Which area(s) are affected with Melasma?
If female, have you given birth?
Are you on the birth control pills?
Do you have outdoor activities very often?
WHat kind of Sunscreen do you use?
What is your Skin Type?
Are you on any medication or supplement?
How did you hear about us?
(such as Google, WebMD, etc..)
You may attach (optional) Pictures to help Dr. Li understand the situation: