Patient Forms

Our staff looks forward to meeting you and discussing your dermatologic needs. We strive to keep our appointments on time, as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so that you can accelerate your check-in process. Please download, print and complete the forms and bring them with you to your appointment. If you are unable to download our patient forms, we request that you arrive to your appointment between 15-30 minutes early so that you can have ample time to fill out the appropriate forms.

New Patient Paperwork
DOWNLOAD FORM
Existing Patient Paperwork
DOWNLOAD FORM
Minor Consent
DOWNLOAD FORM
Medical Record Release
DOWNLOAD FORM
Medicaid Waiver
DOWNLOAD FORM

INFORMATION ABOUT HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) describes how your health information (as a patient of this practice) may be used and disclosed and how you can get access to your individually identifiable health information. Our practice is dedicated to maintain the privacy of your personal health information (PHI). Please read the HIPAA Privacy Rule carefully.