PATIENT INFORMATION

With our online patient portal you can access your health records and lab results, directly message clinic staff, and see your upcoming appointments. If you would like to sign up for the patient portal or are having trouble accessing it, please notify our reception staff.

NEW PATIENT PAPERWORK
PATIENT PORTAL
NEW PATIENT PORTAL INSTRUCTIONS

New patients can enter their medical history directly into their chart by using our patient portal. If you do not wish to utilize the patient portal, you may print the forms from this page and bring them, completed, to your appointment.

After you schedule your first visit over the phone, a receptionist will email you a link to activate your portal account. To protect patient privacy, you must activate your account within 72 hours or the link the will expire. In order to get a new link, you must call our office during business hours to request one. After you activate your account, you can log on as often as you like.

 

Our portal system does not require you to complete certain sections before moving on to the next, so we ask that you please enter the information according to the following instructions in order of which they appear:

 

Contact Info

Please fill this out as thoroughly as possible. If you do not know the answer to some of these questions or do not care to provide the answer, please select "unknown" or "decline to specify" from the drop-down selections instead of leaving it as "unspecified."

 

Insurance and Pharmacy

You can verify your insurance and add your preferred pharmacy if you choose, but this is optional.

 

Medications

If you are currently taking any prescription medications, please enter them individually under the "Add a Medication" feature. Please indicate the strength and frequency of each medication. If you do not take any medications, click "Mark no Medications."

 

Allergies

If you are allergic to any medications, please enter them individually under the "Add a New Allergy" feature and indicate what reaction symptoms you experience. If you have no medication allergies, click "Mark no Known Allergies."

 

Past Medical History

If you are currently being treated for another medical issue, please indicate those here. If you have had surgeries in the past, please indicate what type of surgery, as well as the approximate date of the procedure.

 

Skin Disease History

Please fill out this section as thoroughly as possible. If you have a family history of non-melanoma skin cancer, please indicate that later in the Family History section.

 

Social History

Please indicate your smoking status. Other social history details are optional.

 

Further sections are not required. However, if you have a family history of non-melanoma skin cancer, skin disease, or other condition you feel we should know about, please enter these individually under the Family History tab.

Monday - Thursday     8:00 am - 5:00 pm

Friday - Sunday            Closed
 

Arlington Dermatology Clinic

Tel: 817-265-1356        Fax: 817-261-4309

© 2019 Arlington Dermatology Clinic