A first step for any equipment order is for the completion of a Patient Consent Form. This allows us to check benefits and communicate with your doctor regarding your order. If you did not complete a Consent form at the clinic, please complete this form online using BoldSign or print the PDF form and fax or email to us.  Completing this form does not obligate you to make any purchase.

You will be re-directed to the BoldSign website

Phothera or Kernel Phototherapy Orders

After Dermitech receives the Patient Consent Form, we will check your benefits (if requested) and contact you to discuss your options.  If you agree with the pricing and terms, a Dermitech representative will send you an order form.  Payment will be due (if any) at this point.  Dermitech may email a payment link or you can learn more about other payment options below.