Patient Forms

New Patient Paperwork

Please print and fill out these forms before arriving for your appointment as a new patient. Be sure to bring a valid, government issued photo ID. We also ask that you bring a current copy of your insurance card as this will be submitted with any laboratory or pathology specimens.

Telemedicine Consent Form

Secure File Upload

Medical Records Release

This form is used when you would like to request your medical records.

Family and Friends Release

This form is used if you would like to give our office permission to speak to someone other than yourself regarding your personal medical history, office visits, pathology results, etc.

Third Party Release

This form is used when a third party, such as a life insurance company, is requesting your medical records.

Please note that there may be a fee associated with releasing your records; this office policy is listed in our new patient paperwork. A completed form may be faxed, mailed, or dropped-off in person to our office. Please do not email the completed form.

Our Location

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Hours of Operation

We are open SOME national Holidays.

FDL Dermatology

Monday:

9 AM-4 PM

Tuesday:

9 AM-3:30 PM

Wednesday:

9 AM-3:30 PM

Thursday:

11 AM-7 PM alternating Thursdays

Friday:

9 AM-3:30 PM

Saturday:

Call for Availability

Sunday:

Closed