Online Appointment Request Form
Patients visiting Grafton Dermatology and Cosmetic Surgery for the first time will be required to complete certain forms pertaining to our office policies, insurance, and other procedures; as well as, medical history and how your medical records and other information will be handled (HIPAA).
These forms will be provided to you when you arrive at our office. However, you may save time by bringing these completed forms to our office when you come to your appointment.
Please download and complete all 5 forms:
Medicare Patient Registration Form >> download
medicare form
Patient Information Sheet >> download
patient information
Adobe Acrobat Reader must be installed on your computer to open these forms. You may download the program for free here:
