Filling out form - Dermatology Associates of York, PA

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Health History Form Options

Please fill out a Health History Form and bring the completed form with you to your appointment – alternatively, you could go into our “Patient Portal” and fill out the form there.  Please see the instructions for both options here below: 

1)  Print out your Health History Form using the following link and bring the completed form with you when you come for your appointment: Health History


2)   Complete the Health History Form electronically through Patient Portal Log-in.

For information about the Portal Page click here      

The following forms are for informational purposes and will be signed electronically in the office at the time of your appointment:

Notice of Privacy Practices

Consent & Authorization

Communication Consent

Medicare Authorization

Non-Participating Insurance Authorization

Participating Insurance Authorization

Medical Records Release

Consent for Medical Photography Options

Patients will be asked to complete a “Consent for Medical Photography”.  You may either print this form from home using the following link and bring it to your appointment or you may complete it when you arrive for your appointment.