EZ SPOTCHECK DATA FORM (1)  
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INSTRUCTIONS: This form consists of two (2) parts: (1) DATA FORM (2) IMAGE UPLOAD FORM. Please, start here on this form part (1). Then, press "SEND" to transfer the entered form data when you have finished your data entries. Then, click the button at the bottom of the page to proceed to the image upload form (2).
STEP 1: FILL IN YOUR ORDER NUMBER (see AUTHORIZATION EMAIL):  

 STEP 2: ACKNOWLEDGE DISCAIMER (see beneath) BY CHECKING "ACCEPT".  Accept
DISCLAIMER: Assessing the photographic object displayed in a digital image of a suspicious skin lesion is not a medical service dealing with either diagnosis or treatment. Our expertise judgement rendered is based on image analysis technology only and reflects the analysis of the digital structures depicted. Therefore, this is an assessment of a digital image, not of a real finding. If you wish to have a medical examination, you should arrange an in-person appointment with your physician instead, or in addition. Information provided by the Melanoma Research Project does not replace in-person professional clinical examination and health care. Under no circumstances, the Melanoma Research Project will be liable or held responsible for any adverse effects on health and/or outcome of disease or disease intervention subsequent to electronic consultation/information. In no case, clinical in-person examination, diagnosis, and treatment by a physician can be replaced by any kind of electronic consultation. Using the Melanoma Research Project Services implies the user's acceptance of the limitation of liability.

STEP 3: ENTER ADDITIONAL DATA.

Please, give us some additional data to better process your request. NOTE: The data provided is kept confidentially. IMPORTANT: WE CANNOT PROCESS YOUR REQUEST WITHOUT YOUR EMAIL ADDRESS. If you don't get a reply, please notify us immediately.

Please, enter additional information on the image uploaded here (location, size in MILLIMETERS, history of development):

 

Last Name

 

First Name

 

Middle Name

 

Title

 

Gender

 

Date of Birth

 

Age

 

Country

 

State

 

City

 

Street

 

ZIP Code

 

EMail

 

Phone

 

Fax

 

Skin Color

 

Site

   

STEP 4: PRESS "SEND" TO SUBMIT YOUR DATA (OR PRESS "CLEAR" TO RESET THE FORM ENTRIES TO ZERO TO RE-ENTER DATA).

STEP 5: CLICK "PROCEED" TO PROCEED TO THE UPLOAD FORM (2). HAVE YOU RENAMED YOUR IMAGE FILE TO "LASTNAME.JPG"?

 

PROCEED

Please, click here to proceed to image upload form...
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