new patient forms

Important Dermatology Links New York City


New Patients

Welcome to the New Patient Registration area. If you are a new patient, whether you have an appointment or plan to make one soon, it is important that we take the time to register you in our system. By taking a few moments now to fill out our registration paperwork and fax it to us, it will help us to serve you more quickly when you arrive for your appointment.

Please select and open the following PDF file, and print out all 6 pages from your computer (Adobe Acrobat Reader required).

Don’t have Adobe Acrobat Reader:
Adobe Reader
Download Adobe Reader.

It is important that you fill out all of the required information on all of the documents, and be sure to include your signature where required. If a document does not apply to you, such as an insurance form if you are self-paying, please disregard it. After the applicable documents have been filled out, please fax them to our office at: (212) 391-8601.

A cover sheet is not required. Our fax system is completely secure, and HIPAA compliant. If you do not have a fax available, please be sure to bring these documents with you for your first visit.


Appointments

We thank you for choosing Laser & Mohs Dermatology of New York, and for helping us to serve you better. If you have not made your appointment yet, please visit our make an appointment link to get started. We look forward to seeing you.

Contact Us Today

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NYC Dermatologists
130 W 42nd St #1900 | New York, NY 10036
Hours: Monday – Friday: 7:30AM – 8PM
T. 212.391.8600 | F. 212.391.8601