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Patient Paperwork


New Patients

Your first visit to The Midwest Dermatology involves a few special steps so that we can get to know you and your medical history. Below you will find information on what to expect during your visit and important paperwork. Please try and complete the new patient paperwork prior to your appointment to expedite the registration process.

What To Expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It will also help alleviate any unnecessary anxiety you may be feeling prior to your first appointment. Educate yourself on your symptoms by reviewing the content on this Web site. We encourage you to take some time to review our providers page and familiarize yourself with the provider you will be seeing. We look forward to your first visit.

New Patient Paperwork

Patient Registration Form

HIPAA- Patient Consent Form

Medical History Form

Other Forms

Minor Patient Consent Form

Release of Medical Records

Patient Financial Policy

Patient Bill of Rights

HIPAA - Notice of Privacy Practices

HIPAA - Dependent Patient Consent Form

Patient Portal Instructions

Conditions & Treatments

Our Locations

Choose your preferred location