Follow the steps to complete the appointment request form

1. Click 'Get Form' button to obtain the form and open it for editing.
2. Enter the patient’s name in the designated field. Ensure the name is spelled correctly for accurate identification.
3. Input the date of birth of the patient. Use the format MM/DD/YYYY for consistency.
4. Fill in the patient’s address, including street, city, state, and zip code. This information is crucial for the appointment confirmation.
5. Select the patient's insurance provider from the options provided. This helps with billing and insurance verification.
6. Enter the patient’s phone number in the specified field to facilitate communication regarding the appointment.
7. Provide the name and phone number of the referring provider. This is important for the coordination of care.
8. Indicate how you would like the appointment confirmation. You can choose between email or fax by selecting the appropriate option.
9. Input the preferred appointment date and time in the provided fields. Offering multiple options can increase the chances of securing an appointment.
10. Describe the reason for the appointment clearly. This information assists the dermatologist in preparing for the visit.
11. Once all fields are completed, review the form for accuracy. Ensure that all required fields are filled out appropriately.
12. Save changes, and choose to download, print, or share the completed form as needed. Then, email it to Shedberg@aadermatology.com or fax it to 865.233.7352.

Complete your document request online to ensure timely scheduling of your dermatology appointment.