NEW PATIENTS

If you are a new patient, printing and completing the following three forms will expedite checking in for your first appointment. Please email the completed forms and a photo of the front and back of your insurance card 48hours prior to your first appointment. If you don’t have a way to print these forms - no worries! We are happy to email or text you the digital forms.

Patients under age 18 must have a parent/guardian or designated adult present, or a “consent to treat minor” form signed by a parent before or at the time of the visit.

Phone: (650) 323-0276

Email: Info@CraneStreetDermatology.com

New Patient Registration Form

Medical History Form

HIPAA (Notice of Privacy Practices) Consent Form

Medical Records Release Form