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Virtual Consultation

Consult with Key Laser Institute in the Privacy of Your Home!

To assist our patients that don't live in the Portland, Oregon area, we've developed this Virtual Consultation Form. The virtual consultation allows you to share information about your current condition and desired outcomes with Dr. Key before you visit us.

Fields marked with * are required.
First Name:	*
Middle Initial:
Last Name:	*
Date of Birth:
Gender:
Height:
Weight:
Email Address:	*
Best Phone Number:	*
Area(s) of Concern:	*
Procedure Most Interested In:		-- select one -- Accent™ Affirm™ BOTOX® Cosmetic Combined Laser Treatment Cool Touch™ CoolBreeze™ DOT Therapy EVLT Fat Injection Fraxel Laser Treatment Gentle Waves™ GentleYAG™ Injectable Treatments Intense Pulsed Light (IPL) Laser Lipolysis Lipoaspiration LipoSelection® Other Peels Photodynamic Therapy (PDT) Portrait™ PSR Pulsed Dye Sclerotherapy Skin Care SmartLipo™ Laser Lipolysis Thermage™
Enter the word from this image in the box below:
Enter Code Here:	*

If you have some photos of yourself that you would like to share, please use the upload buttons below to send them to us. For best results: Use a solid background. Take one frontal photo of yourself centered and facing forward. Take two photos at 45 degree angles to the camera, one to the left and one to the right.
Example frontal view.	Example 45 degree left.	Example 45 degree right.
Photo 1: Photo 2: Photo 3:

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   By checking this box you agree to the Terms of Use. *

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