Make a payment: click here to enter your invoice number and payment amount.

Protected: Patient Forms

This content is password protected. To view it please enter your password below:

Password:

Registration Forms

New Patient History
Medical Records Release
Consent for Treatment of Minors

Patient Information

Privacy Policy
Pre-op Instructions
Post-op Instructions
Financial Policy
Financial Policy (Español)
HIPAA policy (text and email)
HIPAA policy (text and email – Español)
Nondiscrimination Policy
Medication list
Disabled Patients Policy (Coming Soon)

Other

Cosmetics
Make a Payment

Phone: 919-791-0840

Fax: 919-791-0911

© 2025 Family Dermatology

Web Design & Development:
Native State Design Co.

Date of Birth:

Leave this empty:

<

>

Home
Services
Staff
Policies
Locations
Patient Portal