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Dermatology Associates of Atlanta, Physicians - Specialists, Atlanta, GA

 

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DERMATLANTA.COM > PATIENT FORMS

Patient Forms

New Patient Registration and Health Information Forms

Please download and print these two pdfs: New Patient History Form, and Patient Registration Form. Fill out your information, and bring these with you when you come into our office. Thank you!

Please click here to view our HIPAA policy regarding the privacy and dissemination of patient information as of 2/24/2010.

Authorization for Use/Release of Health Information Form

Please download and print this pdf: Authorization for Use/Release of Health Information. Fill out the information and bring it with you when you come into our office. Thank you!

The Surgical Suite Forms

Please download and print these three pdfs before visiting The Surgical Suite: The Surgical Suite Patient Notitification, Notice of Privacy Practices, and The Surgical Suite Privacy Practices Notices Acknowledgement. Fill out your information, and bring these with you when you come into our office. Thank you!

Patient Post-Experience Survey

Please download and print this pdf: Patient Post-Experience Survey. Fill out the information, and fax to us at 404-843-3469 or or you may complete it and e-mail it directly to us online.

If you prefer to fill out the survey online instead, please click here. Thank you!

The content on Dermatology Associates of Atlanta’s website is intended to educate patients about skin conditions and treatments, but is not to be taken as medical advice. Dermatology Associates of Atlanta is not responsible for any omissions of information or any damages arising from the display of said content. Dermatologic treatment must be determined on a per patient basis by a board certified physician. It is recommended that you obtain assistance from a licensed professional for any treatment questions.

Click below for directions to our office from:
Atlanta | Chamblee | Dunwoody | Marietta | Norcross | Roswell | Sandy Springs | Smyrna | Tucker