For over 30 years, Brian P. Mekelburg, has been dedicated to providing the best in dermatologic care at the Cedars-Sinai Medical Towers in Los Angeles, CA. Dr. Mekelburg is certified by the American Board of Dermatology, and is a fellow of the American Academy of Dermatology and the American Society for Dermatologic Surgery.

 

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    Have you had any surgeries on the following organs?

     

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      Previous dermatologic or allergic history?

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      Do you have a family history of Melanoma?
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      If yes, which relatives?

      Have you had any of the following skin conditions?

      Do you wear sunscreen?
      YesNo

      If yes, what SPF?

      Do you tan in a tanning salon?
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      Have you ever had an operation? (required)
      YesNo

      If so, what kind of operation(s)?

      Are you pregnant?
      YesNo

      If so, how many months?

      Have you had any surgeries on the following organs?

      Any other info you feel we should know about your health?

       

       

        Your Name: (required)

        Your Email: (required)

        Family Physicians Name: (required)

        Physicians Telephone: (required)

        Physician's Address:

        Are you taking any medications? (required)
        YesNo

        If so, what medications?

        List significant current illnesses?

        Select any of the following medical conditions that you currently have?

        Previous dermatologic or allergic history?

        Family dermatologic or allergic history?

        Do you have a family history of Melanoma?
        YesNo

        If yes, which relatives?

        Have you had any of the following skin conditions?

        Do you wear sunscreen?
        YesNo

        If yes, what SPF?

        Do you tan in a tanning salon?
        YesNo

        Are you subject to any of the following: (Select all that apply)

        Have you ever had an operation? (required)
        YesNo

        If so, what kind of operation(s)?

        Are you pregnant?
        YesNo

        If so, how many months?

        Have you had any surgeries on the following organs?

        Any other info you feel we should know about your health?