Form Links
Albany Dermatology Privacy Notice
Albany Dermatology Patient Consent Form
Albany Dermatology Cosmetic & Esthetic Services Self-Assessment Form
Albany Dermatology Insurance Form
Albany Dermatology Registration Form
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HIPPA Notice of Privacy Practices for Medical Information

Please click below to obtain the Privacy Notice and Consent Form, which describe how medical information about you may be used and disclosed as a patient of Albany Dermatology and how you can get access to this information. Please review this information carefully.


We are required by law to provide you with this Privacy Notice that explains our privacy practices with regard to your medical information and how we may use and disclose your protected health information for treatment, payment, and for health care operations, as well as for other purposes that are permitted or required by law. You have certain rights regarding the privacy of your protected health information that are also described in this Privacy Notice and Patient Consent Form.


 
Patient Information
All new patients at Albany Dermatology are required to complete the following forms:
 
 
Albany Dermatology has provided these forms to expedite your check in. Please print and fill out the appropriate forms, and bring them with you to your first visit. If you will be using insurance for covered services, please also bring your insurance card with you to your appointment.
 
Returning patients will need to complete these forms on an annual basis.
 
In addition, patients for cosmetic and esthetic services will be asked to complete the following form: 
 


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