your first visit
Welcome to ClearlyDerm Dermatology and thank you for allowing our team to care for you today.
During your first visit, in addition to the medical consultation, we will collect information on your medical history, current health and medical insurance. Please be sure to bring a photo ID and, if you have insurance, your insurance card.
If you have an upcoming appointment, you should receive a version of our new patient forms via text message which you can complete and submit right from your smartphone device prior to your visit. If you didn’t receive them and prefer to complete and submit the forms virtually, please call us or email firstname.lastname@example.org to request the link for online forms. If you prefer to print and complete the forms to take with you to your appointment, please download the forms below.
If you are currently taking any medications, please have that list available when you fill out the form. It is important for us to know if you are taking any medication (e.g. heart medications, aspirin, anticoagulant therapy, etc.). Also, please tell us if you have any medical conditions (e.g diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.).