Patient Forms

Easily access our patient forms.

Please remember to bring your driver's license and your insurance card to your appointment.

For all new patients, and all existing patients from over 1 year ago, please complete and bring in the following forms to your appointment:

Patient Forms
Patient Information & Dermatology Medical History [PDF]

Minor Treatment Consent

If you are the parent or legal guardian of a patient who is a minor, and wish to allow the patient to be seen by a provider without you being here, please complete and forward to us the following form:

Medical Records Request

Please note these patient instructions for medical record requests. Camelback Dermatology & Skin Surgery outsources our release of information process to HealthMark Group. To follow up on the status of your medical record request, you may contact HealthMark Group directly at (800) 659-4035 or

HealthMark Group fulfills all patient requests for personal copies at no charge to the patient. A complimentary copy of your record will be made available through HealthMark Group’s website. First time users are required to register for an account before accessing the website. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.

You may also submit a request electronically to HealthMark Group by registering for an account. Once logged in, you may select Submit Request from the menu options and enter all required fields to submit an authorization to HealthMark Group directly. HealthMark Group will process your medical record request and provide notification via mail or email once complete. A complimentary copy of your record will be made available for you to download through HealthMark Group’s MedRelease 360 website

Give us a call to schedule an appointment!