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.

Instructions are as follows; Print forms, hand-write information and bring to your appointment.

Biopsy Waiver

Demographic Dermatology Form

Financial Policy

Medical History

Medical Records Release Dermatology

Treatment of Minor

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.”