new patient registration form

Please click the button below to download a PDF of the new patient registration form (2 pages total). Please bring your completed paperwork with you to your first appointment. Thank you, and we look forward to meeting you!


notice of privacy practices

Please click the button below to download a PDF of our Notice of Privacy Practices (7 pages total). You may also request a printed copy from our office. 


laser hair removal forms

Prior to your appointment for laser hair removal, please fill out this medical history and consent form that is specific to laser treatment. Please click the button below to download a PDF of the laser hair removal forms (5 pages total). Thank you!


medical skincare forms

Prior to your appointment, please fill out this separate medical skincare assessment and consent form that is specific to chemical peels and dermaplaning. Please click the button below to download a PDF of the medical skincare forms (4 pages total). Thank you!


Dermatology Associates of Northwest Indiana, PC

Merrillville/Valparaiso phone: 219.769.7060
Munster phone: 219.513.9415

email: hello@dermatologyindiana.com

fax: 219.440.4855