Please download and print all of the following forms and bring them with you to your appointment:

Form Name

Description

Patient Demographics

Patient Demographic Information

Privacy Practices

Notice of Privacy Practices

Financial Responsibilty

Patient Financial Agreement

Signature Page

Acknowledgement of Receipt of Notices

Medical History

Patient Medical History

Record of Disclosures

HIPAA Patient Record of Disclosure

The forms below may also be of assistance to you:

Form Name

Description

Minor Consent

Established Patients Ages 16-17

Records Release

Tarrant Dermatology to Receive Records

Records Release

Tarrant Dermatology to Send Records