New Patient Registration
NOTE: If your form does not submit when clicking the “submit button” at the bottom of the page, it is likely because you have omitted a required field. Please review your form for these omissions.
NOTE: If your form does not submit when clicking the “submit button” above, it is likely because you have omitted a required field. Please review your form for these omissions.
Ready, Set, Go!
If at all possible, please complete the appropriate forms in the comfort and privacy of your home and bring the completed forms with you to your appointment. This will help to expedite the check-in process and cause less wait time for you in the reception area.
Please remember to bring your insurance card to your appointment so we can make a copy for your file and ensure that your insurance is filed correctly. There are two ways in which you can complete the forms:
- Print and fill out by hand
- Complete using the interactive fields and then print
Authorization and Consent Forms
- Authorization for and Consent to Release Information TO MetroDerm, P.C.
- Authorization for and Consent to Release Records FROM MetroDerm, P.C.
Pre- and Post-Procedure Instructions
- Pre- and Post-Operative Preparations for Mohs Surgery and Excisions
- Instructions for Post-Operative Wound Care for Biopsies
- DermaSweep Post-Treatment Instructions
- Fractional CO2 Laser Pre- and Post- Treatment Instructions
- Sclerotherapy Post-Operative Instructions
- Post-EVLT (Endovenous Laser Treatment) Instructions