Patient Registration

The following attached forms are our Patient Information Package. Please complete these forms to help us maintain accurate contact and medical records. We understand that there are many choices in the community for a Dermatologist and feel privileged to have a chance to care for you. We value the trust that you have placed in us and hope to provide the best treatment options in a caring manner.

Liberty Dermatology specializes in the diagnosis and treatment of skin, hair and nail disease, skin cancer surgery, as well as cosmetic dermatology. We provide our patients and their families with comprehensive skin care.

We hope to deliver care in a friendly environment. We also hope that you find this experience to be a satisfying one. We value patient feedback and would love it if you communicate with us your experience with the practice. If you have any questions or concerns, please do not hesitate to ask any member of our team.

ITEMS THAT WILL BE REQUESTED

• Insurance Cards if you have health insurance
• Driver’s License or State / Government Photo ID
• Co-pay or Deductible is collected at the time of visit
• Cosmetic procedure fees are due at the time of visit
• Completed Patient Registration Package
• Written Referral from Primary Care Physician if required by insurance plan

FORMS TO DOWNLOAD

• Patient Registration Packet
• Medical Records Request
• Treatment of Child Consent Form
• Procedure Consent Form