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.
- Form A (Adult): New Adult Patient Registration Forms
- Form B (Pediatric): New Pediatric Patient Registration Forms (including “Treatment Consent for Minors”)
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.
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.