The following patient registration forms can be downloaded to your computer and printed at home. In order for our physicians to provide a complete and comprehensive medical opinion it is important that they review all your medical information. Please be prepared to provide this information to our office along with your current medical insurance card and photo I.D. Below is a link to our patient registration forms. If you have any questions about these forms, our staff will assist you with your questions on the day of your visit.
Please note, the following forms are only for patients scheduled specifically for a hair loss consultation with Dr. Emily Wise. Because of their time consuming nature, hair loss evaluations are not performed during skin exams or visits for other dermatology issues.
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If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon ‘Get Acrobat® Reader’. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.