Adult & Pediatric Dermatology, PC®
Patient forms are provided on our website for your convenience. Click on the links below to print out the forms that you need. **New patient forms are for patients who have never been seen by an APDerm® provider or for patients who have been seen, but it has been more than three (3) years since their last appointment.** If you have any questions or problems, please do not hesitate to call:
General Dermatology: (978) 371-7010
Cosmetic Services: (978) 610-3694
If you would like to transfer your medical records from Adult & Pediatric Dermatology, PC®, please complete the medical records release form for each individual. The release can be mailed (Adult & Pediatrics Dermatology, PC®, 526 Main Street, Suite 302, Acton, MA 01720) or faxed to our office at (978) 371-0522. A $15.00 charge is required to release each of your records. We accept cash, check, MasterCard, Visa and American Express.
Please note that it may take up to two (2) weeks to release your records.
Please select PDF file to download for Patient Forms. **New patient forms are for patients who have never been seen by an APDerm® provider or for patients who have been seen, but it has been more than three (3) years since their last appointment.**
- New Patient Forms
- Mohs Patient Packet
- Permission for Verbal Communication
- Skin Care Consultation
- Laser Hair Consultation
- Medical Dermatology Patient Survey
- Cosmetic Dermatology Patient Survey
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon