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 Education & Information (new!)
Medical Records Transfer
Directions to our Clinic
Forms for other doctor's offices to refer patients
to our Clinic (new!)
Can't view our forms? Download Adobe Acrobat:
are in PDF format and
require Adobe Acrobat Reader. If you don't have Acrobat Reader,
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
Patient Registration - These are our patient registration
forms used by new patients or any patient who has not been seen in our
practice for 3 years or more. Directions to our clinic are also
of Privacy Practices (HIPAA) - INFORMATIONAL ONLY - This is
our notice of privacy practices. It is similar to the HIPAA form present
at any medical facility and explains your privacy rights as a patient in
PATIENT EDUCATION & INFORMATION
Dermatitis - Commonly referred to as ECZEMA. Read about the
condition and treatment options.
Baths - Bleach baths can be an
effective tool for killing bacteria as well as helping to clear atopic
Nitrogen Treatment -
Liquid Nitrogen is commonly used to treat skin pre-cancers as well as
warts, skin tags, and "age" spots. Some treatments are strictly
cosmetic and will not be covered by insurance. Others, such as
skin pre-cancers are generally covered by insurance, but may be subject
to deductibles or co-insurance.
Skin Cancer - Of all types of cancer, skin cancer is the most
common. There are several types of skin cancer and all can be treated if
diagnosed early. The least common, but most dangerous skin cancer
is melanoma. This document contains some pictures of melanomas
that show how it can present in a variety shapes, colors and patterns.
- Molluscum are sometimes referred to as "water warts" because they are
commonly spread in baths and swimming pools. It is a pox virus that can
be treated in a variety of ways.
- what to look for - How do you choose a good sunscreen?
This document explains the various ingredients and how to be a smart
shopper. Don't be hung up on high SPF numbers! The
ingredients, formulation and proper application are far more important.
Care for Biopsies - Biopsies are performed to accurately
diagnose or confirm a diagnosis of a skin lesion. This is a simple
procedure, but proper wound care is important to speed healing and
minimize scarring. The information in this document is given to
every patient who gets a biopsy done in our office.
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
policies or use the form below.
At a minimum, they will require your signature on a release form.
Records Transfer Form - This form may be used to transfer
medical records to or from our office. Fort Mill Dermatology does
not charge to fax your medical records directly to another doctor's office.