Download Forms

All Patients

• Please bring your insurance card and referral from your Primary Care Provider if required by your plan.
• Copay is due at time of registration
• If you have no insurance or are otherwise paying with cash on your own, you will need to arrange payment options with our billing office.
• Children under the age of 18 are required to be accompanied by a parent. A temporary guardian is allowed if there is written authorization from a parent or legal guardian.
• In addition to the above, we recommend printing and completing the following forms prior to your appointment. This will help make your office visit more efficient.
  

New patient forms

• Albemarle Dermatology Associates New Patient Registration Form
• Medical History Form
• Financial Responsibility and HIPAA Disclosure Form

Established patient forms

• Registration Update – Established Patients
• Financial Responsibility and HIPAA Disclosure Form

Other downloads

• Albemarle Dermatology Associates Brochure

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Each document is in .pdf format,
and requires Acrobat Reader to open.