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PATIENT
FORMS
Fort
Mill Dermatology physicians and staff understand that your time is valuable. In
order to make your clinic visit more worthwhile, we’ve included some useful
forms that you can download and prepare in advance of your appointment. Please
bring your completed forms to Fort Mill Dermatology at the time of your next
appointment. Our friendly registration staff will take it from there.
We've also included some helpful informational documents.
Patient Registration
Patient Education & Information
Medical Records Transfer
Directions to our Clinic
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PATIENT REGISTRATION
This
group of forms is necessary for us to see you as a patient at Fort Mill
Dermatology. Please print and fill out these forms completely and bring
them in at your first visit. If you can't bring in these completed forms,
we ask that you arrive at least 20 minutes prior to your scheduled appointment
to allow time to complete them prior to being seen by our doctors.
If you have seen Dr. Rebecca Smith or Dr.
Julie Iannini at their previous Charlotte practices, but not at Fort Mill
Dermatology, you will still need to fill out the Patient Registration forms so
we can get all of your most current information into our new medical records
system.
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PATIENT EDUCATION & INFORMATION
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MEDICAL RECORDS TRANSFER
Excellent care begins with the doctor having an accurate past medical history.
It is also important for us to have a copy of any biopsy reports, particularly
if you have a history of any skin cancers or pre-cancers.
Some clinics will transfer records directly to another physician or clinic at no
charge. However, physicians or clinics may charge a "reasonable fee" for the preparation and/or the
photocopying of medical and other records. This is sometimes a per page
copy charge or a flat fee that is often $10-15. Whether or not your
physician charges for this service is at the discretion of that office policy.
If you need to have your
medical records transferred from another medical office to Fort Mill
Dermatology, you may want to contact them regarding their office procedure.
At a minimum, they will require your signature on a release form. You may
also use the following release form to request that records be transferred to or
from our office. Fort Mill Dermatology does not charge to fax your medical
records to another office.
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