Patient Forms

We want to make your first visit to Dayton Skin Care as pleasant and comfortable as possible. To better serve you, please bring your insurance card with you. If your insurance requires you to have a referral, please bring that with you at the time of your visit. You will be asked to fill out several forms on your first visit.

To save time, we offer the option of completing all of your necessary New Patient Information forms through our website. Simply print, complete and bring the New Patient Information Packet found at the link below with you to your first visit.

Mohs Surgery Patient Paperwork General Dermatology Patient Paperwork

Privacy Policies & Non Discrimination Practices

Note: Notice of Privacy Practices and Patient Rights are for your review and do not require printing, unless you would like to retain a copy for your records.

Privacy Practices

Nondiscrimination Practices

Dayton Skin Care Specialists complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.