New Patient Resources

New Patient Information

Your first visit to Fairlawn Dermatology involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more.

There's also background information about our committed staff and our first visit procedures. You can also save time by printing and completing the forms before your appointment.

Mission Statement

Our practice is working together to realize a shared vision of uncompromising excellence in dermatology. To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earning the trust and respect of patients, profession, and community.
• Exceeding your expectations.
• Ensuring a creative, challenging, and compassionate professional environment.
• Striving for continuous improvement at all levels.

Adult New Patient Forms

Please print and fill out these forms so we can expedite your visit. Please read the last two forms.

• Patient information
• Notice of privacy practices
• Medical history
• Office policies

Pediatric New Patient Forms

Please print and fill out these forms so we can expedite your visit. Please read the last two forms.

• Pediatric patient information
• Notice of privacy practices
• Medical history
• Office policies

Medical Records Request Forms

• Medical records sent to Fairlawn Dermatology
• Medical records requested from Fairlawn Dermatology

Cosmetic Forms

• Esthetician registration form
• Sclerotherapy authorization
• Sclerotherapy questionnaire
• Sclerotherapy instructions
• BOTOX consent form
• Informed consent for non-invasive cosmetic treatments
• Micro-needling consent form

Laser Forms

• Fitzpatrick skin type form
• Patient history form
• Consent form for hair removal
• Consent form for vascular and pigmentation procedure

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

Map and Directions

What to Expect

Being well-prepared for your appointment will ensure that the doctor has all the information needed to provide the best possible care for you. It will also help alleviate any unnecessary anxiety you may feel before your first appointment. Educate yourself on your symptoms by reviewing the content on this website. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.