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Patient Forms

Please fill out these form to get the chart created and for us to have all information for insurance verification. Our Front Desk Patient Coordinator will get in touch with you within 24 hours after you submit this form.

Click or drag files to this area to upload. You can upload up to 4 files.
Please upload front and back of your insurance card as well as your ID so your insurance is verified prior to your visit.

COVID-19 Screening Questionnaire

In an effort to reduce the risk of COVID-19 exposure all patients must complete the following screening questions:

PATIENT PHARMACY CONSENT FORM

NO SHOW AND CANCELLATION POLICY

Dear Patient: Please be advised that as a patient of Hudson Dermatology and Laser Surgery all patients are subject to a "NO SHOW and SAME DAY” cancellation policy and failure to call less than 24 business hours in advance will be charged as follows.
Missed General Dermatology appointment (including virtual): $50

Late cancellation for General Dermatology appointment (including virtual): $50

Cosmetic Appointments: $200

Patch Testing: $100

Any Patch Test appointment scheduled for Monday should be canceled by Friday at noon or a fee of $100 will be charged.

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