Dermatology Patient Forms And Information

Patient forms need to be printed, filled out and brought to the office. Please do not submit your forms through the website.

To save time on the day of your appointment, please fill out these forms and bring them with you:

Dermatology Forms – English 

• CDLS Patient Registration Form
• CDLS Patient Health History Form
• Authorization to Release Healthcare Information
• CDLS Financial Policy
• Consent to Treat a Minor
• Notice of Privacy Practices
• Results Form

Dermatology Forms – Spanish

• CDLS Patient Registration Form (Spanish)
• CDLS Patient Health History Form (Spanish)
• Authorization to Release Healthcare Information (Spanish)
• Financial Disclaimer (Spanish)
• Consent to Treat a Minor (Spanish)
• Notice of Privacy Practices (Spanish)
• Results Form (Spanish)
• Modernizing Medicine Instructions (Spanish)
• St. Vincent Office Information (Spanish)
• Hillsboro Office Information (Spanish)

Please do not fill out any patient paperwork from the portal, this does not get to the office please see patient forms on this website to print, complete, and bring to the office with you.

 

Need Adobe Acrobat Reader?
If you do not have a copy of Acrobat Reader you can get one for free by clicking on the Acrobat® Reader icon. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.