Please download and print all of the following forms and bring them with you to your appointment:
Form Name | Description |
|---|---|
Patient Demographic Information | |
Notice of Privacy Practices | |
Patient Financial Agreement | |
Acknowledgement of Receipt of Notices | |
Patient Medical History | |
HIPAA Patient Record of Disclosure |
The forms below may also be of assistance to you:
Form Name | Description |
|---|---|
Established Patients Ages 16-17 | |
Tarrant Dermatology to Receive Records | |
Tarrant Dermatology to Send Records |