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Patient Forms

Dermatology Specialists of Charlotte Patient Forms

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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:

Required Forms

Patient Registration Form

Patient Registration Form

Medical History Form

Medical History Form

Office Policy Signature Form

Office Policy Signature Form

HIPAA Release

HIPAA Release

Optional Forms

Credit Card Payment Form

Credit Card Payment Form

Review these forms

Patient Privacy Form

Patient Privacy Form

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:

Required Forms

Patient Information Change Form

Patient Information Change Form

Medical History Form

Medical History Form

Office Policy Signature Form

Office Policy Signature Form

HIPAA Release

HIPAA Release

Release of Information to New Provider (when moving)

Release of Information to New Provider (when moving)

Optional Forms

Credit Card Payment Form

Credit Card Payment Form

Contact Us Today

Have questions or concerns? Please give us a call at 704-943-3714.

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