Get Medical History And Intake Form - Ocean State Dermatology

The Medical History And Intake Form is a crucial document required for your visit to Ocean State Dermatology. This guide provides clear instructions on how to complete this form online, ensuring you provide all necessary information for your healthcare provider.

Follow the steps to complete your form successfully

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in your name and date of birth at the top of the form. Ensure this information is accurate as it helps in identifying your medical records.
3. Move to the Past Medical History section. Here, you will see a list of medical conditions. Circle all conditions that apply to you, ensuring that you include any significant medical history.
4. Next, proceed to the Past Surgical History section. Similar to the previous step, circle any surgical procedures you have undergone, including any relevant details.
5. In the Skin Disease History section, circle any skin conditions you have experienced. This information is critical for your dermatological evaluation.
6. Indicate whether you wear sunscreen and if you tan in a salon. Provide further details as requested.
7. If applicable, enter information about your family history of melanoma and any other relevant family medical history.
8. You will then need to enter your current medications and any known allergies. Be thorough in this section to prevent any complications.
9. Fill out the Social History section by circling your smoking and alcohol use status. Provide details on your daily routine, caffeine use, occupation, and workplace.
10. Lastly, complete your residence information before signing the form and dating it at the bottom.
11. Once you have filled out all sections, save your changes. You may then choose to download, print, or share the completed form as needed.

Start filling out your Medical History And Intake Form online today to help us provide you with the best care possible.