Forms

New Patients

Thank you for choosing Midlothian Dermatology. We are excited to meet you! Please review all of our forms and policies before your appointment and arrive 10 minutes early for your appointment. Please print, complete, sign, and return the following forms on the day of your visit:

1. New Patient Registration Form

2. Medical History Form

3. HIPAA Acknowledgment Form

Office Policies & Other Forms

1. Notice of Privacy Practices/ HIPAA

2. Financial Policy

3. Medical Record Request