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Online Video Consultation Request Form

Complete The Form Below To Request An Appointment

To schedule your online video consultation with one of our surgeons, please complete the form. Once completed, our staff will follow up with instructions and an appointment time that works for you. If you have any questions, please contact our office at (504) 455-9960.

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In order for our doctors to get a better understanding of your condition and accurately determine the appropriate treatment, please take at least two pictures that clearly represent your areas of concern.

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HIPAA Privacy Policy

Our office is dedicated to protecting the rights of our patients and the confidential information entrusted to us. We are committed to developing technology that gives you the most powerful and safe online experience. The form information provided is stored securely as required by the Health Insurance Portability and Accountability Act (HIPAA) and the state of Louisiana and will only be seen by the doctors and staff at Oral Surgery Services. Learn more about our HIPAA Privacy Policy.