Dermatology Center Of The Palm Beaches, P.A.

Lake Worth: 561-968-7546 Boynton Beach: 561-742-2252

Medical Forms

Dermatologist (Forms) are available to you:


The Privacy Policy contains all required HIPAA information for you to read and sign.

We value your privacy and we want you informed about your care and procedures. If there is any area that is unclear, please do not hesitate to contact us for an explanation.

The Patient Medical Sheet must be completed so we are aware of your medical history, conditions and medications. This is important information for your physician regarding your care.

The Assignment Agreement allows you to provide insurance information in order for us to have it on file. Your signature allows us to submit your claim to them for billing.

Our Financial Policy details how payments is made and the terms of payment. This form also explains the insurance billing process as well as information on co-payments.

Contact us to learn more or make an appointment today!

Patient Forms

Privacy Policy : Download
Patient Medical Sheet : Download
Assignment Agreement : Download
Financial Policy : Download

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Dermatology Center of the Palm Beaches offers adult and pediatric dermatologic services in two convenient south Florida locations; Boynton Beach and Lake Worth.

To See A Full List Of Our Medical Services Click Here: