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    Stutz Dermatology

    Patient Forms

    Complete these forms before your appointment to help us prepare for your visit and make the most of your time with us.

    Patient Forms

    The forms listed below are available when you arrive at the office. You can also call ahead if you have questions about what to bring.

    New Patient Registration

    Required for all new patients. Please complete before your first appointment.

    Medical Request Form

    Fill out this form and provide it to your doctor to authorize the transfer of your medical records to our office.

    HIPAA Privacy Consent

    Authorization for use and disclosure of protected health information.

    Questions About Forms?

    If you have questions about any of these forms or need assistance completing them, please contact our office staff. We are happy to help.

    Phone: 248.651.9500