Man filling out patient forms

New Patient Paperwork for Creedmoor Patients

Patient Forms

Since we value your time, please review the following information prior to your visit so we can focus our time on your skin care needs. Please print all pages, complete and return by mail, e-mail, or fax prior to your next appointment. You may also bring the completed forms to your first visit.

Mailing Address: 7200 Creedmoor Road, Suite 104, Raleigh NC 27613

Fax Number: 919-518-0939

Email: admin@creedmoorskinsurgerycenter.com

Intake and Medical History Form

Patient Intake Form

View Intake Form

Financial Policy

Financial Policy, Consent, and HIPAA Acknowledgement Form

Financial Policy Form

Medical Release

Patient Medical Release Form

Medical Records Release Form

Treatment of Minors

Consent Form for Treatment of Minors

Treatment of Minors Form

Reminder: Please bring all insurance cards and photo identification on the day of your appointment.