ASSOCIATES IN MEDICAL AND COSMETIC DERMATOLOGY
Crozer Medical Plaza at Brinton Lake
500 Evergreen Dr, Glen Mills, PA 19342
Suite 20: Medical & Surgical Dermatology:
484.785.3376 (DERM)
Suite 27: Cosmetic Dermatology:
484.785.7546 (SKIN)

New Patient Forms

New Patients

Please arrive 15 minutes early for your first appointment, so that you will have ample time to check in and complete your new patient paperwork. Brinton Lake Dermatology greatly appreciates you being on time for your appointment so that you are able to maximize your appointment time and so that our other patients are not inconvenienced.

As a new patient, we will have you fill out registration and medical history paperwork. Registration and medical history forms may be completed online or in person as follows:

Registration paperwork

  1. Online — Print and complete your registration forms before your appointment and bring the paperwork to your appointment.
  2. In person — Come in 15 minutes before your appointment to fill out registration paperwork.

Download the Patient Registration Form

Medical History paperwork

  1. Online — Print and complete your medical history forms before your appointment and bring the paperwork to your appointment.
  2. Online — When making your appointment, our scheduling staff can give you a link to our medical software which enables you to input your medical information directly into your medical chart. Go green! Be sure to ask for this link when making your appointment.
  3. In person — Come in 15 minutes before your appointment to fill out your medical history paperwork.

Download the Patient Medical History Form

Medical Records Request Form

If you would like to have your previous medical records sent to our office, please print and complete the following form so that we may request your records.

Download the Medical Records Request Form

Philadelphia Phillies: Striking Out Skin Cancer

Philadelphia Phillies: Striking Out Skin Cancer

We would like to send a big shout-out to the Philadelphia Phillies for recently placing 12 sunscreen dispensers in Citizens Bank Park as part of a “Sun Smart America” initiative. Phillies Hall of Famer MikeRead More...