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Admission Forms
In an effort to expedite the check-in process for new patients and to reduce your waiting time at Bernardo Dermatology Medical Group, please download the appropriate PDF file, print them out, then complete and sign. Be sure to bring them with you when you come for your appointment.

The "Patient Financial Policy" PDF file is a two-page form.
Click here to view the Patient Financial Policy Form

The "Adult Form" PDF file is a four-page form.
Click here to view the Adult Form.

The "Medical Record Release" file is a one-page form..
Click here to view the Medical Release Form.

The "Children Form" file is a three-page form.
Click here to view the Children Form.

The "Credit Card Form" file is a  one-page form.
Click here to view the Credit Card Form.

The “Financial Responsibility For MOHS Patients” PDF file is a one page document.
Click here to view the Financial Responsibility For MOHS Patients document.

The “Notice of Privacy Practices 2013” DOC file is a seven page document.
Click here to view our Notice of Privacy Practice document.

We're looking forward to seeing you soon!


The latest Adobe Reader software is required to view the forms and is available for download free at www.adobe.com

 
 
 
Dr. Francis A. Barber, Jr
Dr. Ruth A. Larson
Dr. Shauna A. Schneider
Dr. Lynn P. Shipman
Dr. Elizabeth E. Vierra
Dr. Mark A. Vierra
Dr. Vanessa London
Leah Larson, N.P
 
 
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