Patient Photo
Please submit photos for surgical cases
Here
Doctor
*
First Name
Last Name
Patient Identification Code (PIC)
*
Required for case communication to maintain HIPPA compliance. Please enter existing PIC (already used within your office). Or Create a 5-7 digit code (alpha & numerical) Example: Pt. John Doe = D13578
Patient Name
First Name
Last Name
Lab Location
*
Durham/Greensboro
Charleston
Wilmington
Shade
Photo Upload
Browse Files
Cancel
of
Comments
Submit Order
Should be Empty: