In order to provide you the most complete and safe service, we need you to fill out a few forms regarding your personal information, insurance information, and medical history. It is important that you fill out these forms as completely as possible prior to your visit to the doctor's office.
(requires Adobe PDF)
The last page of the registration forms refers to our Privacy Practices, which are standard to most physicians’ offices. Feel free to review our NOTICE OF PRIVACY PRACTICES.
If your child is a minor and you will not be able to accompany him/her to the appointment, please complete the AUTHORIZATION FOR TREAMENT OF A MINOR FORM in addition to the patient registration forms. We will not be able to see or treat your child without the completed form.
If you have any questions, don't hesitate to call or email us at OFFICE@ALPINEDERMCLINIC.COM.