1.  Registration Form:                                                         Registration.doc

2.  Medical History:                                                            Patient Medical Data.doc  

3.  Permission to Provide care to a Minor:                  Minor Care.doc

4.  Privacy Notice:                                                              Privacy Notice.doc

5.  Release Form:                                                                Privacy Release.doc

6.  Release of Medical Information:                              Release of Medical Records.doc

7.  Satisfaction Survey:                                                     Satisfaction Survey.doc

8.  Acne Instruction Sheet:                                              Acne Care Instructions.doc


When you click on these files they will download as a Microsoft Word document.  You can either print them off, complete them and bring them with you to your appointment or you can fax them to our office at 615-443-4180.  You can also complete them and email them to us at: lebdermcenter@gmail.com.  

NEW PATIENTS
You need only complete the Registration Form and the Medical History for your initial visit.  We prefer to have your forms completed 2-3 days prior to your arrival in our office so that we can complete your registration into our computer and make your office visit as efficient as possible.  

If you are a new patient or haven’t been seen in over 3 years please arrive 15 minutes before your appointment to complete paperwork and allow us to update/enter your information.  If you are an established patient arriving for follow-up please arrive 5 minutes before your appointment.Forms_files/Registration.docForms_files/Patient%20Medical%20Data.docForms_files/Minor%20Care.docForms_files/Privacy%20Notice.docForms_files/Privacy%20Release.docForms_files/Release%20of%20Medical%20Records.docForms_files/Satisfaction%20Survey.docForms_files/Acne%20Care%20Instructions.docmailto:lebdermcenter@gmail.comNew_Patients.htmlForms_files/Registration_1.docshapeimage_3_link_0shapeimage_3_link_1shapeimage_3_link_2shapeimage_3_link_3shapeimage_3_link_4shapeimage_3_link_5shapeimage_3_link_6shapeimage_3_link_7shapeimage_3_link_8shapeimage_3_link_9

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Links

  1. •www.aad.org

  2. •www.skincancer.org

  3. •www.melanoma.org

  4. •www.dermnet.com

  5. •www.allergan.com

  6. •www.psoriasis.org


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