Get History And Intake Form - Central Dermatology Center - Centralderm

Filling out the History And Intake Form for Central Dermatology Center online is an essential step in preparing for your appointment. This guide will help you navigate each section of the form with ease, ensuring accurate and comprehensive information is provided.

Follow the steps to complete your form effectively.

1. Begin by pressing the ‘Get Form’ button to access the History And Intake Form. This will allow you to open the form in a format that is ready for completion.
2. In the first section, enter your personal details such as your full name and date of birth. Ensure accuracy in spelling and format.
3. Proceed to fill in the date of your appointment and provide the name and location of your primary care physician.
4. Clearly state the reason for your visit to the dermatology center. Additionally, include your occupation.
5. Indicate how you learned about the center by selecting from the provided options such as physician, friend/family, website, etc.
6. In the medical history section, carefully circle all applicable conditions that you currently have or have had.
7. Do the same for the surgical history section, circling relevant past surgeries.
8. Complete the skin disease history section by circling any known skin conditions.
9. Answer the questions regarding your family history of melanoma and other skin cancers.
10. List all medications you are currently taking, including prescriptions, over-the-counter items, and supplements.
11. Fill in the name and location of your preferred pharmacy.
12. Note any known drug or contact allergies along with your specific reactions.
13. Indicate your smoking and alcohol usage by selecting from the options provided.
14. Review the symptoms listed in the review of systems section, marking 'yes' or 'no' as appropriate.
15. Lastly, complete the alerts section to indicate any current health alerts that may be relevant.
16. Once you have filled out all sections, you can save the form changes, download, print, or share it as necessary.

Take the first step towards your dermatology appointment by completing the History And Intake Form online now.