Waccamaw Dermatology Patient Forms

We want to thank you for taking the time to review our Waccamaw Dermatology patient forms. We strive to provide you with all the necessary patient forms in advance for your ease.

For an overview of our Waccamaw Dermatology Patient Forms, please read below.

Demographic Information

The demographic information form records necessary patient information such as your name, address, contact information, employment/education information, spousal information, race, ethnicity and emergency information.

Patient Signature Form

The patient signature form confirms the patients’ choice to receive care, the release and use of patient information as needed, the acknowledgment of receipt of HIPAA privacy and permission to contact the patient.

Medical History

The medical history form records critical information about your health that may affect your treatment plan. This includes questions regarding your skin, occupation, allergies, medications and more. We ask that you complete this form honestly and in as great detail as possible. If you do not understand a question, please feel free to call us for more information. If you are unaware of a current or past medical condition, please contact your primary health care provider for more information.

Note: When filling out the Waccamaw Dermatology Patient Forms, please make sure to give detailed information to the best of your knowledge so that we can provide optimal care. If you have any questions about the forms, please feel free to contact us. Our dedicated and knowledgeable staff are more than happy to help you complete your forms.