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