Patients who are new to Midwest Dermatology Clinic, or who have not been seen within the past 12 months, must complete and sign a new patient registration form. In addition, the authorization to release form must be signed as indicated.

To make check-in quicker and easier, print out the attached forms and fill them out, answering all questions and signing as indicated. Please print neatly to avoid any mistakes in your medical records. Then, bring the completed form with you to your appointment and hand it to our check-in receptionist. The doctor will see you shortly thereafter.

Registration and Medical History Form
Authorization Form