Aloha Dermatology LLC
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Caring for your skin with Aloha.....


Patient Registration

 We know your time is valuable and to speed the process of initial patient registration we suggest the following:


Download the following forms which can be completed on your computer prior to printing (if prefered, they can be filled out by hand after printing).  Please bring them to your first visit along with your insurance card if you want us to file for you to receive reimbursement.

Patient Registration Form ( please fill out)

Medical History Form (please fill out)

Financial Policy (please fill out) For HMSA, HMSA 65C Plus, Medicare or BC/BS

For all other insurance: Financial Policy (please fill out)

HIPPA Form (just read)

Office Policy (Please READ)

It is also important to bring in (or have a list) of any medications you are on, any allergies you have, and any skin medications or treatments you used in the past or are presently on.  This should be done for any and every doctor visit to insure your safe and effective health care.