The following packet can be downloaded to your computer and printed at home. Please fill this out and bring to your appointment to save time in the office. You may also fax these forms to us (704-341-0092) to minimize your wait time at the office.  Please bring your original forms to the office as well.   If you have any questions, please fill in as best you can and our staff will help you with your questions on the day of your visit.

Patient Forms

• Forms to be completed by new patients
• Patient Registration form
• Patient History form
• Signature form
  
  
• Policies to be reviewed by all patients
  • Office Policy
  • HIPAA Policy

As a new patient, it would be helpful to have any pertinent information forwarded from either your primary care provider or previous dermatologists.   This includes the following:

• Any treatments for skin conditions, pathology reports and surgeries from past skin cancers.
• Request records from other offices.  This is a formal request in writing to the office of your referring or previous doctor. Please note that as a new practice, we will need relevant records from all of our patients.   Please send the Medical Records Release form to your doctor's office and request your relevant medical information to be faxed to our office at 704-341-0092 prior to your appointment.
• Please bring all your prescription medications with you to the first visit and any subsequent visit when these medications have changed.   Bring all prescribed creams and pills for your skin condition to each appointment.
• Please bring a current insurance card.
• Physician Referral Forms, if required by your insurance carrier.

For existing patients, please notify us of any changes using the Patient Information Change form.