Patient Forms: Please feel free to print all six of the following forms prior to your first appointment and have them filled out before your arrival.

New Patient Policies: All patients are required to provide the following items of identification at the time of their first appointment:

1. Photo ID (e.g., driver’s license, military, etc.)

2. Proof of Insurance (insurance card, insurance plan number, etc,)

Please Note: All deductibles and co-pays must be collected from our patients at the time that services are rendered as they represent a contractual obligation established between each individual insurance carrier and this medical practice.

New Patient Forms Include:
Patient Medical History
General Information
Notice of Privacy Practices/HIPAA
Patient Consent to Release Medical Information
Patient Policies and Guidelines

Click to Download and Print the New Patient Forms
Please Note: All forms must be filled out in black ink.

Notice of Privacy Policies:

HIPAA Notice for Park Avenue Dermatology

Request for Medical Records to be sent to Park Avenue Dermatology:
Request for Medical Records Form

Medical Records Release from Park Avenue Dermatology
Medical Records Release Form

Additional Forms you may need at Park Avenue Dermatology

Post-op Wound Care Instructions

Post Liquid Nitrogen (LN2) and Canthacur Instructions

Consent to Surgical- Biopsy Procedure and Anesthesia

Minor Consent Form

Note – In order to download the Patient Information forms you will need Adobe Reader. Adobe Reader can be downloaded for free at this link.

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