Patient Forms

If you are a new patient to Atlantic Dermatology, we thank you for choosing us.

For your convenience, please find below two important forms we need to evaluate your past and current skin history, and to admit you into our dermatology clinic.

There are two ways you can fill out the below forms:
• Enter information using your computer; print out; bring to appointment.
• Print forms, handwrite information; bring to appointment.

Patient Information Form

Please call us at (757) 481-1666 if you have any questions about these forms, or if you need assistance.

“No-show policy: Scheduled appointments are considered a contract to reserve time with our physicians. Our office requires at least 24 hours prior notice if cancellation is necessary. Patients who do not keep their appointment and fail to notify us will be charged $50.00. This will be the patient’s responsibility to pay, will not be billed to insurance, and will be due before future appointments can be scheduled.”

If you have a skin condition in need of evaluation and treatment, please contact our dermatology clinic at (757) 481-1666. We serve Virginia Beach, Chesapeake, Norfolk, Portsmouth, Hampton Roads, Eastern Shore of Virginia and Maryland, and the Outer Banks of North Carolina. Our dermatologists are here to help you.

About our dermatology clinic
For more than three decades our dermatologists have been successfully treating adults and children in Virginia Beach, Chesapeake, Norfolk, Portsmouth, Hampton Roads, Eastern Shore and Outer Banks, N.C., who suffer from acne, eczema, moles, skin growths, cysts, nail disorders, psoriasis, rashes, rosacea, skin allergies, skin cancer detection, skin discoloration, warts and other skin problems. Our dermatologists also care for our patients cosmetically through botox fillers, and leg vein sclerotherapy.

Atlantic Dermatology Associates, P.C.
Medical Arts Bldg., 1101 First Colonial Rd., Suite 200, Virginia Beach, VA 23454  |  Ph: (757) 481-1666     Fax: (757) 481-7696
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