Request for Photo Investigations

Please complete the form below to submit a referral consultation for specialty photo investigations. We will respond within 98 hours on working days.

Referring Physician Name *

Hospital / Institution *

Referring Physician Email *

Patient Name *

Patient Email *

Provisional Diagnosis / Reason for Referral *

Investigation(s) requested

Monochromator phototesting Photoprovocation testing Minimal erythema dose (MED) Photopatch testing Other

Submit referral request

Or send directly to contact.sunrise@chula.ac.th