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 Receipt of Financial Policies and Notice of Privacy Practices
DAWPA Medical History Rev 8-5-22
DAWPA Medications and Allergies
Our physicians absolutely prefer that legal guardians accompany children. If a legal guardian cannot accompany a minor patient for their appointment, the consent provided below should be signed/returned to our practice.
DAWPA Consent to Treat a Minor
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.