Gardens Dermatology & Cosmetic Surgery Center
11030 RCA Center Drive
Suite 3015
Palm Beach Gardens, FL 33410
(561) 776-7041

Paperwork/Forms

 
 
 
 
 
 
 

New Patient Paperwork

 

Other Paperwork

  • Update Form
    The update form is for returning patients who have had a change of address and/or insurance. This form is also mandatory if a returning patient has not completed an update form since 2005. Any returning patients who have not been seen since 2004 or earlier are required to fill out a new patient packet.
  • Aesthetician Form
    This form is for patients who have not seen an aesthetician at Gardens Dermatology or have not seen an aesthetician at our office since 2004 or earlier.
  • Treatment for Minors
    This form is needed if a minor patient plans to attend an appointment at Gardens Dermatology without their parent or guardian present. This form must be filled out in full for the minor patient to be seen and will be filed in the minor patient's chart for future use.
  • Medical Records Release
    Patients may complete this form if they wish to obtain their records from another doctor for the purpose of being seen at Gardens Dermatology or if they wish to obtain a copy for their personal benefit. This form is also used if Gardens Dermatology needs to send medical information from our office to another doctor for the purpose of patient care.