Forms

The following forms are provided for you to speed up the check-in process.

Patient Privacy Notice

Good Faith Estimate

US Government Information Form / 15 Common Languages

Video Visit Child Authorization Form

... note that the information on these forms and all your personal health information can be completed securely on-line on your personal Patient Portal account... 

What may I have to pay on the date of service, and what if I no-show?

If you need your medical records released for any reason, or would like another other medical provider(s) to release your medical records to Advanced Dermatology Associates, LTD, please print and complete the following form: 

Patient Medical Records Release Form