Patient Forms

To ensure we deliver you the best patient experience, reviewing the applicable documents to understand our policies and procedures and completing the appropriate forms in advance of your visit will enable us to serve you better.

First-time patient?

New patients are required to complete the new patient medical paperwork. Your visit with us will run more smoothly by completing the paperwork ahead of time.

New Patient - Medical Paperwork

Established patient?

Thanks for trusting us with your care. If it's been over a year since you last updated your information with us, complete the form with your current information.

Established Patient - Annual Update

Need your medical records?

If you or any designated entity needs your Clearline Dermatology medical records for any reason, complete and submit the authorization form to us. It may take 7-10 business days to initiate the release depending on the volume of records and the intended recipient(s).

Medical Records Release Authorization

What is our privacy practice policy?

We take the security of your personal and health information seriously. As a convenience to our patients, a full copy of our Notice of Privacy Practices can be accessed here. A copy is always available for review in our office.

Notice of Privacy Practices