We understand that your time is very valuable. To help us accommodate you in a more timely manner, please print and complete the forms below (as needed), and bring to your first appointment. Also, if your information has changed, please print and bring a new copy.
If you have any questions related to a particular form or section, feel free to ask when you sign in on the day of your appointment.
All of the following forms are in Adobe Acrobat (PDF) format:
- History and Intake Form
- Consent, Disclosure and Authorization Form
- Billing Policy
- Notice of Privacy Practices
- Patient Authorization for Practice to Release Protected Health Information
- Patient Authorization for Practice to Receive Protected Health Information
In addition to the completed forms, also please be sure to bring your insurance card and a valid ID to your appointment. We will make a copy to include in your file.
Once you are an established patient you may access your medical records at http://hmgderm.ema.md with a unique password that will be assigned to you.