Carlyle Dermatology Carlyle Dermatology

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Forms & Policies

I would like to take this opportunity to welcome you to Carlyle Dermatology and to thank you for choosing our organization for your healthcare needs. Our physicians and staff are committed to providing you with the highest quality healthcare in a comfortable environment. Our physicians are board-certified and committed to promoting good health and guiding patients toward a healthy lifestyle. 

In order to make your first visit as pleasurable and efficient as possible, please complete our new patient forms and questionnaires prior to your scheduled appointment. You may complete these forms either by using our secure online portal (Your Health File) or downloading and faxing or mailing the completed forms to our office. Patient’s electing to self-register using our secure online portal can email their request to support@carlyledermatology.com. An invitation will be sent to the email address provided with instructions and a link to begin the registration process. 

Alternatively, to view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at http://www.adobe.com/. Please fax, mail or bring your completed forms with you to our office at the time of your visit. 

New Patient Forms 

  1. New Patient Packet
  2. New Patient Welcome Letter
  3. Practice Policies
  4. Patient Registration 
  5. Assignment of Benefits
  6. Notice of Privacy Practices and Patients’ Rights (Read)
  7. Acknowledgement of Notice of Privacy Practices and Patient Consent
  8. Health History Questionnaire

Medical Records Request 

  1. Authorization for Use or Disclosure of Protected Health Information (If Applicable)

Please remember the following items for your first appointment: 

  1. Copies of your completed new patient forms and questionnaires 
  2. Insurance card(s) 
  3. Current medications 
  4. Pertinent medical records, operative reports, x-rays, and laboratory results 

Also, we request you to arrive at least 30 minutes prior to your initial visit so that you may be properly registered and acquainted with our facility and staff.