Patient Forms


For your convenience, your paperwork and forms are listed below. We know your time is precious.

Please have these ready for your appointment!

New patients must print off, read, complete and sign all attachments below.

Existing patients will be asked to update their health history annually, and with any policy changes.

We strongly encourage you to log into your patient portal to complete your health history and registration information. It is important you keep this up-to-date. Please check back regularly to update your health information.

We look forward to taking excellent care of you!

Patient Information

Consent To Treat

Privacy Policy

Financial Policy

Hair Loss Questionnaire


Parkland Dermatology & Cosmetic Surgery
4360 North State Road 7
Coral Springs, FL 33073
Phone: 754-999-3376
Fax: 833-279-7072

Office Hours

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