Patient Forms

We value your time!

The Medical History & Registration forms are available for patients to download, print, and complete prior to the appointment.

 Patient Forms & Policies 

Notice of Privacy Practices

 Patient Registration

Prescriptions and Refills

 Consent to Treat Minor

 Acne Assessment

Hair Loss Evaluation

 HS Questionnaire

 Psoriasis Questionnaire

 Medical Record Release To Another Physician

Medical Record Release From Another Physician

Please fax a completed Medical Records Release form to our office at (832) 871-4112 , or you can email your request to staff@yourclearskin.com . We will be more than happy to transfer records as soon as possible to facilitate your medical care.

Please note that a fee may apply for obtaining records for personal use or other purposes (such as life insurance policy determination).

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 Click here to download it.