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Forms

Please  fill out these forms and bring them with you when you come for your appointment or email them back to us at info@carolinaskinsurgery.com

As you know, email is not secure and has a number of risks that you should think about.  Your use of email is an acknowledgment of this insecurity and your acceptance of the risk.  If you do not want to email your forms, you may fax them to the office at 704-295-0005 or mail them to 2615 East 7th Street, Charlotte, NC 28204.

Pre-appointment Forms

This form needs to be filled out and signed if:

  1. you are a new patient
  2. you have had any changes since your last appointment (i.e.: medical history changes, address changes, etc.)
  3. you have not been seen at the practice in the past six months.

registration-form-rev-3-23-17

 

Forms to review before your appointment:

Please review this form before your first appointment. You will sign for this via electronic signature while present at the office.

HIPAA Form ( 25k PDF)

Please review the following forms before your first appointment.  You will sign for both of these forms on the Registration Form (see above).

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authorization-to-release-medical-benefits-read-only-rev-12-6-16

Pre-Operative Instructions:

Please review this form before your Mohs surgery appointment, sign at the bottom of the page, and bring to your appointment.

Pre-Op Instructions ( 100k PDF)

Post-Operative Wound Care (for after surgery appointments):

We will give you a copy of the form based on the type of repair that you have before you leave the office.  These forms are available online for informational purposes or if you lose the form that is given to you at your appointment.

Post-Op Wound Care-Wounds With Stitches ( 25k PDF)

Post-Op Wound Care-Skin Graft – no Bolster ( 25k PDF)

Post-Op Wound Care-Skin Graft – with Bolster ( 22k PDF)

Post-Op Wound Care-Healing On Its Own ( 25k PDF)

Post-Op Wound Care for Biopsies (16k PDF)

Instructions for Acetaminophen and Ibuprofen rev 4-6-15

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Navigating the Patient Portal After your appointment:

Here are some helpful tips and instructions for navigating the patient portal after you have an appointment at our office.

Screen shot instructions for Pt. Portal rev 11-7-14