new patient forms

Please click the button below to download a PDF of the new patient forms (8 pages total). You may fax your completed forms back to us at 219.440.4855 or bring them 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. 


established patient update

Please click the button below to download a PDF of the established patient update form (1 page total). Thank you for being a valued patient!


laser hair removal forms

Prior to your appointment for laser hair removal, please fill out this separate 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/Valpo phone: 219.769.7060
Munster/Whiting phone: 219.513.9415

email: hello@dermatologyindiana.com