Patient Forms.Below are the forms needed for a new patient's integration as well as an authorization for treatment of a minor form and a request for records.
Please feel free to print and bring with you at the time of your visit. Your insurance card will also be required for your initial time in our office. |
New Patient
If it's your first time visiting our office, or you have not been seen in 3 years, you may print these forms to save yourself some time at your initial visit.
| Notice of Privacy Policies |
| ccof_financial_policy |
| hipaa_privacy_policy_and_consent |
| medical_history_form |
| patient_registration |
| surprise_balance_billing_disclosure_form.pdf |
Authorization to Treat a Minor
If you feel your under 18 year old child can be seen in our office without you being present please fill out the form below and send it with your child at the time of their visit. It will stay on record for 1 year.
| authorization_to_treat_a_minor.pdf |
Request for Records Release
If you have recently changed practices, moved to the area, or would like to keep another physician abreast of your dermatologic visits you can fill out the form below and return it to our office for your records to be released to whomever is specified.
| request_for_records_release.pdf |
