Schedule an In Person or Virtual Consultation

For the convenience of our patients, Dr. Galiano offers In-Person and Virtual Consultations. To schedule your appointment, please fill out the form below and select which type of appointment you prefer. For Virtual Consultations, Dr. Galiano requests patients provide some photos which you can submit on the form below. Virtual Consultations will take place over Zoom.

Read the Steps Northwestern Medicine is taking for our patients’ safety. Click Here.

Virtual Consultation Form

What Type of Consultation Would You Prefer? * First Name * Last Name * Phone Number Email Address * Address City State Zip Age Gender Time Frame for Surgery: Procedures of Interest Questions / Message *

If scheduling a Virtual Consultation please use the upload button below to submit photos to us. To make the most out of your Virtual Consultation, do your best to submit your photographs with multiple angles. Accepted file types: jpg, jpeg.

Complete the equation before submitting the form

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