Now accepting Telehealth appointments. Schedule a virtual visit.

Forms and Paperwork


 

DOWNLOADABLE FORMS

To save time and make the process more convenient, you can fill out several forms at home before your appointment. Just click on the button below to print out a copy of the form on your printer, fill it out and bring it to your appointment.

Forms are available in Adobe Acrobat PDF format. Please click the link to download the appropriate form:

New Patient Paperwork

REGISTRATION FORM

Patient Registration form

 

 

HEALTH HISTORY (2 PAGES)

View/Download PDF

 

Don't forget to bring your photo ID, insurance card, and prescription card to your first visit!


Additional Forms 


CONSENT & PRIVACY FORM

View/Download PDF

 

 

PRACTICE POLICIES

View/Download PDF

 

 

PATIENT AUTHORIZATION TO DISCLOSE HEALTH INFORMATION

View/Download PDF

 

 

AUTHORIZATION TO PROVIDE TREATMENT TO MINORS

View/Document PDF

 

 

EDUCATIONAL RESOURCES

To help you stay informed, listed below are some materials and videos that can help you identify and prevent skin cancer as well as links to the top dermatology websites.

VIDEOS AND FLYERS

Sunscreen Information Flyer (pdf)

Self Exam and Body Mole Mapping Instructions (pdf)

How to apply Sunscreen (video)

How to perform a self exam (video)

WEBSITES

American Academy of Dermatology https://www.aad.org/

American Society for Dermatologic Surgery https://www.asds.net/Public-Resources/

Spot the Spot, https://www.spotthespot.org/

The Skin Cancer Foundation, https://www.skincancer.org/

American Cancer Society, https://www.cancer.org/

Our Locations

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