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1-866-400-DERM (3376)

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at many of our 150+ locations.

Customer Service

Patient Forms

At Advanced Dermatology and Cosmetic Surgery, we believe superior customer care begins before you arrive at the doctor's office. That's why we provide all the necessary forms for our newest patients. If you prefer to complete these forms in the convenience of your own home or office, just print the appropriate forms (Personal Information, Consent for Treatment, HIPAA Acknowledge Receipt, Medical History, and Notice of Privacy Practices), fill them out and bring them with you to your first appointment.

Medical History
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Minor Children

Parent or legal Guardian must attend the initial appointment with the child and all appointments involving invasive treatments.

Minor children must be accompanied by a parent or authorized individual age 18 or older for all appointments.

In the event the parent cannot bring the child to subsequent routine appointments, parent or legal guardian can execute the Parental Temporary Assignment of Authorization to Treat Minor Child.

Signature must be witnessed by staff of Advanced Dermatology and Cosmetic Surgery.