Online Patient Portal/Electronic Medical Records
For your convenience we have provided a way for you to update your medical history and also retrieve your medical records online from our practice when necessary.
You will need a Username and Password that can be provided by the office staff upon request.
Please fill out your medical information as accurately as possible. We need to know frequency and dosages of any medications you are taking. We also need to know, if you are allergic to something, what kind of reaction you have.
Our Electronic Medical Records system does not allow patients to change address, name, phone #, email or insurance information. If any of this information is incorrect, please inform the front office when you are checking in or you can email us any changes to: email@example.com
For those of you that prefer to print your forms ahead of time and fill them out to bring in with you, we have those forms available below as well.
Simply click on the appropriate Forms button and all necessary forms will be available.
- Medical History – New Cosmetic Patient
- Medical History – New Mohs Patient
- Patient Demographic Information
- Patient Consent For Use And Disclosure Of Protected Health Information
- Do Not Take List of Medicines
- “Slow Mohs” for Atypical Moles and Melanoma
- Patient Notification of Ownership & Advance Directives
- Patient Rights & Responsibilities
- Chemical Peel: Pre-Op — Post-Op
- Liposuction: Pre-Op — Post-Op
- Wound Care: Post-Op
- Sclerotherapy FAQs