Consultation Online

Submit photos and concerns for a preliminary assessment from Dr. Pongsak

Online assessment — this is not an appointment booking

Send your photos and concern and Dr. Pongsak will reply by email within 24–48 hours. This form does not reserve a clinic visit or a time slot. If you would like to see the doctor in person, please book an appointment instead.

Book an Appointment

This assessment is preliminary guidance only, not a medical diagnosis. Actual results may vary. Please schedule an in-person consultation for a thorough examination.

Patient Information

Title *

First name *

Last name *

Email *

Additional information (optional — speeds up your visit) Optional

Date of birth

Use Christian Era year (e.g. 1985)

Address

Medical Information Optional

Allergies

Current Medications

Service of Interest

Type of Treatment *

Describe Your Concern

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Upload Photos (optional — photos help the doctor give a more accurate assessment)

Tips for good photos:

Take a clear front-facing photo
Take photos from both sides
Use natural, well-lit lighting
No makeup if possible

Choose photos...

Upload up to 5 photos (JPG, PNG, WebP, max 10 MB each)

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