Patient Forms
Dermatology Specialists of Charlotte Patient Forms
Providing your information
For your convenience, we have a couple of options that will allow you to provide your patient information to DSC. One option is using our online portal; the other is to download forms on this web site, fill them out at home and then give the forms to our receptionist on your visit. The instructions below will provide guidance to new patients and to existing patients.
For new patients…
On your first visit, you will need to complete the following the following forms, either online or usings the forms below. You will also need to read other forms listed:
Patient Registration Form
Medical History Form
HIPAA Release
For existing patients…
If any of your original information changes or you have updates to your insurance of medical history, you can use the following to update:
Patient Information Change Form
Medical History Form
HIPAA Release
Release of Information to New Provider (when moving)
Have questions or concerns? Please give us a call at 704-943-3714.