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Patient Forms


New Patient Forms

In order to make a first visit seamless, we recommend that new patients complete the forms below prior to their first appointment and then deliver the forms to the reception desk on the day of the first appointment. Arriving to your scheduled appointment with your prepared forms will significantly decrease your time in the waiting room. We also ask that you bring with you a photo ID, insurance card and a list of any medications you are currently taking. We do accept insurance, and payment is accepted at the time of service.

Thank you for scheduling your appointment at the Dermatology Institute & Skin Care Center. We look forward to meeting you soon!

Please contact us at (310) 829-4104 if you have any issues downloading the forms or have questions about any particular form.




We are committed to providing you with exceptional care in a timely manner. For this reason, we have instituted a 24-hour cancellation policy for all appointments. The office needs to be notified 24 hours prior to the appointment date in order to avoid a cancellation or no-show fee of $50 for medical and $100 for cosmetic. We appreciate your understanding and cooperation.

Please download, read and sign the forms below.





As your health care provider we are tasked with providing you a notice on how we may use and share your health information and detailing your health privacy rights.
Click below for more information.


Dermatology Institute & Skin Care Center
2001 Santa Monica Blvd, Suite 1160W
Santa Monica, CA 90404
Phone: 310-829-4104
Fax: 310-829-4150

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