Thank you for visiting the dermatology website. Please complete the form below to formally submit a request for cosmetic services from the Dermatology Department at Walter Reed National Military Medical Center.

Filling out this form DOES NOT GUARANTEE that you will receive cosmetic treatment - cosmetic services are only offered when there is time and space available. When space is available you will be contacted by email. You will have 48 hours to respond before having your name removed from the list and that appointment time given to another person.

DO NOT CALL/EMAIL THE DERMATOLOGY DEPARTMENT TO ASK WHERE YOU ARE ON THE LIST. THE ADMINISTRATIVE STAFF DO NOT HAVE ACCESS TO THIS INFORMATION.

IF YOU DESIRE MORE URGENT COSMETIC TREATMENT, YOU SHOULD PURSUE THIS IN THE CIVILIAN SECTOR.

YOU MUST READ COSMETIC POLICIES PRIOR TO SIGNING UP FOR CONSULTATION
Dermatology Cosmetic Policy 2021, click here.

Last Name *

First Name *

Prefix/Sponsor last four (xx/xxxx) *

Email address *

1. I have read and understand the clinic policies document. * YesNo

2. I understand filling out this form does not guarantee treatment. * YesNo

Dermatology Cosmetic Procedure

REQUEST