Remote Consultation Service

Remote Consultation Service

Pennsylvania, New York, New Jersey, Maryland, Delaware or Washington DC residents, you can begin a remote consult by following these steps:

You will need to sign & submit the following consent forms:

DOWNLOAD CONSENT FORM HERE

Forms need to be signed and returned to telehealth@shields.md

 

 

As this process consists of multiple steps & gathering of multiple pieces of information, it may be more conducive to use a computer, rather than a phone or tablet, to complete the process. When compiled, you can send a single email to telehealth@shields.md to submit your consultation request.

 

The fee for this service is $50

Step 1

What is the reason for your consultation with us?
Please fill out this form & submit to telehealth@shields.md

DOWNLOAD FORM

Step 2


Do you currently have any...

Discharge?
Discomfort/Pain?
Redness?
Swelling?
Blurry/Double Vision?
Send your answers to telehealth@shields.md

 

Step 3

 

Please take the following 3 online vision tests (click here) and send your results to telehealth@shields.md

Step 4


Take photographs of the affected eye:

Using a cell phone camera with the flash turned ON, hold phone 4-8 inches away from the patient. To ensure focus, tap the screen until the picture is clear.
Do not zoom. Make sure patient holds both top and bottom eyelids open.

Screen Shot 2016-05-05 at 1.40.17 PM

Take photographs of the following gazes for the affected eye(s):

Screen Shot 2016-05-05 at 1.51.53 PM

 

Email photographs of the affected eye to telehealth@shields.md