New Patient Forms

If you are a new patient to Ada West Dermatology, please select one of the pertinent registration forms below to print off and fill out.

At your first scheduled appointment, please bring this form, your driver’s license, medical insurance card(s) and (if applicable) your referral authorization to expedite the new patient registration process upon your arrival.

Office Policies

Medical Records Forms

At Ada West Dermatology, we recognize that you sometimes need to transfer medical records to and from our clinic. Should you need to request outside medical records to send to Ada West Dermatology, please use Form 1. Should you need to release your medical records from Ada West Dermatology to another outside office, please use Form 2.

Telehealth Smartphone Setup

If you have an upcoming Doxy.me telehealth virtual appointment, your smartphone/tablet will need to be setup before the first visit. This is a one-time setup that will allow your device’s camera and microphone to connect to your clinician by live video in a virtual exam room on the Doxy.me website. Just click on the device-specific instruction set that applies to you–instructions on page 2 are also included on what website to link up to based on your scheduled provider:

Android Phone/Tablet Patient Doxy.me Setup and Connection Instructions

iPhone/iPad Patient Doxy.me Setup and Connection Instructions

Once you have setup your device using the above instructions, please go to this website to test/verify your setup before your virtual appointment: https://doxy.me/precall-test/

Surgical Instructions

Pre-operative Care Instructions
For the patient that will be undergoing an outpatient procedure at our clinic.

Post-operative Care Instructions

For the patient that has already undergone an outpatient procedure at our clinic.

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