(310) 939-9800

1636 Aviation Boulevard Ste. 201
North Redondo Beach, CA 90278

New Patient Forms

Congratulations!

You are now part of The Derm Institute family!

Please complete the New Patient Forms below and bring  them in on the day of your appointment. This will significantly shorten your waiting time at the office and make your visit more relaxing and timely.

New Patient Forms

  • Please complete the New Patient Forms below and bring  them in on the day of your appointment. This will significantly shorten your waiting time at the office and make your visit more relaxing and timely.
  • If it is a medical visit, make sure we are a provider with your insurance company.
  • Bring your current Insurance Card and Driver’s License.
  • Find out if any referrals, deductibles, and co-pays required for your visit.
  • If you have any outside reports or records you would like us to review, please request them from that office and bring them to your visit with us.
  • Dependents under the age of 18 should be accompanied by a legal guardian
  • Please review our Notice of Privacy Practices.
  • Please also review this sample Physician-Patient Arbitration Agreement as you will be asked to sign it in the office upon your first visit.

Click Here for Entire New Patient Packet

Or if you prefer to download the forms individually:

If you have any questions or concerns with any of the above, our team will be happy to answer them on the day of your appointment with us.  We look forward to seeing you!

 

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