GENERAL DERMATOLOGY AND SURGERY PATIENTS

If you are a new patient or have not been seen by one of our providers during the previous three years, please fill out all four forms prior to your appointment.

If you are a returning patient but have not completed paperwork over the past two years, complete the first two forms prior to your appointment.

DAWPA Demographics Rev 1-17

DAWPA Receipt of Financial Policies and Notice of Privacy Practices

DAWPA Medical History Rev-3-19

DAWPA Medications and Allergies

 

Upon your arrival, a Patient Care Coordinator will enter your demographic and insurance information into our computer system.  They will also scan your current insurance card(s) and take your photograph.