Patient Forms

Patient Forms

If you are a new patient to our practice, we recommend you complete your new patient information online.  Please call our office and we can provide you with your personal access information.

Then go to our patient portal by clicking here -> or follow the directions in the email you receive. Please note the email will be coming from Premier Dermatology LLC

We hope you will find this an easy way to provide us with your important health information.

Patient Forms

New Patient Forms

New Patient Registration Form PDF

Patient Portal Information PDF – Link:

(Please complete Medical History on Patient Portal. If you did not receive the login/password, call our office)

New Patient Registration Package (Please print and bring on the day of your appointment)PDF

Mohs Surgery Forms

Patient Information Brochure PDF

Overview Information PDF

Pre-Treatment Information PDF

Post Operative Wound Care PDF


Medical Records Release Form PDF

Patient Survey PDF

Cosmetic Treatment Forms


Pre-Treatment Information PDF

Pre-Treatment Questionnaire PDF

Post Treatment Information PDF

CO2 Laser

CO2 Laser Consent Form PDF

CO2 Laser Medical History Form PDF

CO2 Laser Pre-Treatment instructions PDF

CO2 Laser Post Instructions PDF

Office Policies

Notice of Privacy Practices PDF

Financial Policy PDF

Lab Information PDF

Ethnicity & Race Privacy PDF

Driving Directions

We are located on the south side of Bee Ridge Road between Beneva and Lockwood Ridge near the Church of the Palms. Our building is located on the corner of Bee Ridge Road and Iola Drive next to the Al Purmort Insurance building.
From US 41 / Tamiami Trail:
Turn onto Bee Ridge Road and travel East until you cross Lockwood Ridge Road. You will see the Church of the Palms on your right, and then our brown building is the second building on the right.
From Interstate 75:
Take the Bee Ridge exit (207) and head West for approximately 3.5 miles. You will cross over Beneva Road. After the Beneva light, get into the left lane. Our building will be approximately 200 yards up on the left side at the corner of Bee Ridge and Iola before Lockwood Ridge.