Patient Information Patient Portal Go to Portal Online Bill Pay Pay My Bill Request an Appointment Complete the form below and a team member will call you back to get an appointment scheduled. Name* First Last Email* Phone*Appointment Type* Request a New Appointment Request a Follow Up Appointment Reason for Appointment Upload Photos Drop files here or Select files Max. file size: 8 MB, Max. files: 3. Please attach up to 3 photos of the spot on your skin you have questions about. (If having trouble please email fazeliderm@gmail.com directly)