Book a Consultation | Dr. Albert Chung

Long Distance Patient Consultation Request

For patients outside the Orange County area, we offer remote consultation services. Fill out the form below to begin the process.

📋 Remote Consultation Process

Submit this consultation request form
Receive and sign the consultation waiver via email
Complete payment through our secure payment link
Schedule your remote consultation with Dr. Chung

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Important: Emails from Dr. Albert Chung will come from yourfriendlyproctologist@gmail.com. Please check your spam folder and add this email to your contacts.

First Name *

Last Name *

Email Address *

Phone Number *

City, State/Country *

Your Timezone

Preferred Contact Method

Preferred Consultation Time

Have you been a patient of Dr. Chung before?

Reason for Consultation *

Important: After submitting this form, you will receive an email with a consultation waiver that must be signed before scheduling. Following waiver completion, you'll receive a secure payment link. Remote consultations are scheduled after both steps are completed.