NEW PATIENT REGISTRATION
Are you a new patient? Save time and register here prior to your visit.
All NEW PATIENTS are required to fill out paperwork prior to being seen in our office. Below you will find our Medical Questionnaire packet along with instructions on how to submit it. Please note that these packets are in PDF format and will require Adobe PDF Reader to view them.
Instructions:
- Click on the “Medical Questionnaire” form button below
- Fill in as much as you can
- Be sure to sign the document either digitally or manually after printing out the document
- Save the document on your desktop
- Print it or send it to us via one of the methods below
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Medical Questionnaire |
IMPORTANT: Remember to bring the following items with your to your visit:
- Insurance Card
- Identification (Driver’s License, ID Card, or Government Issued ID)
- Authorization Letter (if applicable)
HOW TO SUBMIT YOUR FORM
Via FAX or IN OFFICE
You may print out your completed packet and either FAX it to 310.205.3553 or bring it with you on the day of your appointment.
Via EMAIL
There are two ways you can email your completed Medical Questionnaire packet. You can either send it directly to appointments@bhskin.com or attach it via the “choose file” button below and then send. One of our medical staff members will add the information to your patient account.
