Danbury
New Milford
Ridgefield
Southbury
Dermatology Associates of Western Connecticut, PC
Dermatology Associates of Western Connecticut, PC
Danbury
New Milford
Ridgefield
Southbury

Patient Registration Forms

The following forms may be printed directly from this site, to be filled in at your convenience prior to your appointment. Please be assured that NO information is being transmitted over the Internet; you are merely printing a blank form.

PDF Downloads

Patient Information & Medical History Form (to be filled out by all new patients and once every two years by all existing patients) Please print off this four-page form, complete it, and bring it with you to your appointment.

Notice of Privacy Practices (as required by the privacy regulations created as a result of the federal Health Insurance Portability and Accountability Act of 1996)

Please review our Notice of Privacy Practices prior to completing and signing Section 6 on the Patient Information & Medical History Form (see above).


Dermatology Associates of Western Connecticut