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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!

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!

All data and information provided on this website is for informational purposes only and should not be misconstrued as medical advice. Dermatology Associates of Atlanta makes no representations as to accuracy, completeness, relevance, suitability, or validity of any information on this site and will not be liable for any errors, omissions, or delays in this information or any losses, injuries, or damages arising from its display or use. Treatment information and medical recommendations must be made on a case-by-case basis; it is recommended that you seek personalized care from a board certified medical doctor for any medical questions or health issues you may have.