Southside Dermatology is honored to have you as a patient. Please print out, complete and bring the following patient forms to your scheduled appointment. You will also need your insurance card, driver’s license, and any applicable co-pay, co-insurance, or deductible. In order to expedite your visit, it is important that you have your paperwork and all the required items with you at the time of your appointment. We verify all insurances, therefore please arrive 15 minutes before your appointment time.

If the appointment is for a minor child (age 18 or under), please have available the child’s social security number. If you are not the legal guardian with the child at the time of the visit, a minor patient form must be filled out by the legal guardian to give Southside Dermatology and its providers permission to treat the minor child. Contact our office if you have further questions.

If you are an established patient, please let our receptionist know if any of your information has changed including name, any contact information, insurance, etc. We will ask you to update this information by filling out a patient information form.

If you are unable to keep your scheduled appointment time, kindly notify us within 24 hours to avoid a cancellation fee.

• Patient Registration Form
• General Policy Statement Form
• Medical History Form
• Minor Patient Consent Form
• Cosmetic Consultation & Analysis Form
• Request for Release of Medical Records Form