Get New Patient Intake Form - Physician Skin Solutions

Completing the New Patient Intake Form is an essential step for a smooth experience at Physician Skin Solutions. This guide provides clear instructions to help users accurately fill out the form online, ensuring all relevant information is submitted.

Follow the steps to complete your New Patient Intake Form online.

1. Press the ‘Get Form’ button to access the New Patient Intake Form and open it for completion.
2. Begin by entering your personal information. Fill in your full name, date, address, city, state, zip code, date of birth, and contact numbers. Make sure to indicate the best number to confirm appointments.
3. In the Patient Concerns section, check 'Yes' or 'No' for various skin concerns that apply to you. This includes categories like lines/wrinkles, skin laxity, and others.
4. If you are interested in specific procedures or services, indicate your preference here.
5. Detail your cosmetic procedure history by indicating which treatments you have had. Answer 'Yes' or 'No' for each listed treatment and provide any relevant years for past treatments.
6. Move on to the Patient Medical History section. Again, respond 'Yes' or 'No' for each listed medical condition and provide additional information as necessary for any conditions that apply.
7. List any chronic illnesses, drug allergies, and other allergies you have in the designated fields.
8. Document your current medications and supplements, ensuring to include prescription and non-prescription details. If not taking any, indicate this by initialing in the provided space.
9. Answer questions regarding current use of specific drugs and your smoking history, health status, sun exposure habits, sunscreen use, and alcohol intake.
10. Review the Patient Expectations section carefully. Initial next to each statement to indicate your understanding of the policies regarding cosmetic procedures and follow-up treatments.
11. Decide if you wish to enroll in the rewards programs and provide your member ID if applicable.
12. Finally, sign and date the form to confirm all information is accurate and complete.
13. Once you have filled out all sections of the form, save your changes, and download, print, or share the form as needed.

Start filling out your New Patient Intake Form online now for a seamless experience at Physician Skin Solutions.