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

Registration Form 

Prescription Refills Form  

Consent to Treat a Minor  

Medical Records Release to another Physician 

Medical Records 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).

In order to view or print these forms, you will need Adobe Acrobat Reader installed.
 Click here to download it.