Submit A Case

This service is exclusively for Licensed Healthcare Professionals.

Your credentials will be verified!

1Practitioner & Patient Demographics

2Clinical & Medical Info

3Billing & Confirmation

License State(Required)

Professional Role(Required)

NPI Number(Required)

Clinic/Practice Name(Required)

Patient Gender

Patient Age

Skin Type (Fitzpatrick Scale)

Type I: Pale white skin; always burns, never tans (e.g., Redhead with freckles)

Type II: Fair skin; usually burns, tans with difficulty (e.g., Fair-skinned European)

Type III: Darker white skin; sometimes burns, gradually tans (e.g., Central European)

Type IV: Light brown skin; rarely burns, tans easily (e.g., Mediterranean, Asian, Latino)

Type V: Brown skin; very rarely burns, tans very easily (e.g., Middle Eastern, Indian, some Hispanic)

Type VI: Dark brown or black skin; never burns, deeply pigmented (e.g., African descent)

Other

Quick Links