Patient Forms


Completing your patient forms prior to appointments can help save time. Spectrum Dermatology has six locations in the greater Phoenix and Scottsdale area for your convenience. At each location, medical, surgical, and cosmetic dermatology procedures are available.

Patients and clients who would like help completing forms can arrive early to appointments for guidance and assistance. Forms are available to download in advance and can be completed digitally for added speed and convenience. Download the following forms now:

Dermatology Patient Intake Form

Download Dermatology Patient Intake Form

This form is required for all new dermatology patients and may be required for long-standing patients who have not completed the most recent intake form. It is important to comprehensively complete all questions on the form in order to ensure the best possible outcomes for treatments.

Both medical and cosmetic dermatology patients must complete these forms. It is often best to complete these forms digitally and in advance to make sure that all medications, topical treatments, and past surgeries, skin conditions, and treatments are included. A full history, as well as current medications, are necessary to avoid potential side effects.

Patients should include all current and recent medications and topical creams, including over the counter and natural supplements such as vitamins and pain management medications. Some medications and supplements may negatively interfere with treatments. For instance, blood thinners such as Omega-3 vitamins and many over the counter pain management medications can cause excessive bleeding after some procedures. Patients are often required to temporarily stop these medications and supplements for a certain number of days prior to treatment.

During a consultation with your dermatologist, aesthetician, or injector nurse, you will be provided with information necessary to prep for any treatment or procedure. In situations where medications cannot be stopped, alternative treatments may be recommended.

Plastic Surgery Patient Intake Form

Download Plastic Surgery Patient Intake Form

Any surgery, whether medical or cosmetic, comes with risks. It is extremely important that the Plastic Surgery Patient Intake Form is completed fully and honestly. Previous procedures, current and past medications, other conditions (not necessarily related to the skin), and current and past over the counter drugs and supplements must be relayed on the form in order to ensure patient comfort and safety.

In some cases, patients may need to complete both the Dermatology Patient Intake Form and Plastic Surgery Patient Intake Form. Forms may need to be completed by current patients to update any outdated patient forms, too.

Cosmetic Questionnaire Form

Download Cosmetic Questionnaire Form

Cosmetic procedures can range from very mild, such as microdermabrasion, to more aggressive including a wide range of laser skin treatments and chemical peels. Completing the Cosmetic Questionnaire Form fully and to the best of your ability ensures the safest and most comfortable cosmetic procedure possible. This includes listing any former procedures, current and past medications, disorders and diseases, and current or past over the counter medications and supplements. Not all patients are a good fit for all procedures, and many times this is discovered through intake forms. In these cases, an alternative treatment might be suggested.

Notice of Privacy Practices

Download Privacy Practices Form

Your privacy and safety are top priorities at Spectrum Dermatology. Patients have rights covered by HIPAA, and it is important to know the parameters of your rights and privacy. This form may be regularly updated with new regulations and rules.

Contact Spectrum Dermatology To Set up Your Appointment

Whether you prefer to complete forms in advance or at one of our six offices, it is the first step in healthier skin. At Spectrum Dermatology, a patient’s safety comes first. Schedule your appointment or consultation today, or call (480) 948-8400 for more information, including advice on completing forms. The experts at Spectrum Dermatology are committed to making the entire process as fast, easy, and comfortable as possible.