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Forms

The Oakview Dermatology Forms website page is a helpful resource for patients, providing access to necessary medical forms that can be filled out prior to their appointment. Patients can easily download and complete these forms, allowing for a more efficient and streamlined check-in process. These forms must be printed out and brought with you to your appointment. 

All new patient paperwork PDF. Including the Patient Intake Form, Demographic Page, Financial Policy, HIPAA, and General Consent.

The Oakview Dermatology Demographics Form collects essential patient information including contact details, medical history, and address. 

The Oakview Dermatology Financial Policy Form outlines the financial responsibilities and policies for patients receiving medical care at our practice.

A HIPAA form reassures patients that their sensitive health information is being handled securely.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. 

A general consent form protects the patient and Oakview Dermatology by ensuring informed consent and clarifying the patient’s rights and responsibilities during treatment.

The Oakview Dermatology Authorization to Treat Minor Form allows parents or guardians to authorize medical treatment for a minor child in their absence. Please note that for the first visit, the parent or legal guardian must be present, even if the Authorization to Treat Minor Form is completed.

The Oakview Dermatology Physician Referral form is designed for healthcare providers to refer their patients to our practice for specialized dermatological care.

The Oakview Dermatology Medical Release Form allows patients to authorize the release of their medical records from other healthcare providers to our practice for the purpose of providing comprehensive dermatological care.

The Oakview Dermatology Medical Release Form enables patients to authorize the transfer of their medical records from our practice to other healthcare providers or medical offices as needed.

The Oakview Dermatology Autopay Agreement Form allows patients to sign up and authorize Autopay through ModMed Pay. 

Contact Us

Doctor using a dermatoscope to examine a patient's skin.

Ohio

2111 East State Street

Athens, OH 45701

P: (740) 566-4621

F: (740) 566-4622

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454 West Central Avenue, Ste B 

Delaware, OH 43015

P: (220) 213-0243

F: (220) 213-0244

80 Star Drive

Chillicothe, OH 45601

P: (740) 672-2160

F: (740) 672-2161

204 Stone Road

Belpre, OH 45714

P: (740) 423-3080

F: (740) 423-3081

2405 North Columbus Street, Ste 100

Lancaster, OH 43130

P: (614) 908-1339

F: (614) 908-1340

5175 Morse Road, Ste 100 Gahanna, OH 43230

P: (614) 454-4808

F: (614) 454-4809

2443 Troy Road

Springfield, OH 45504

P: (937) 505-6505

F: (937) 505-6506

South Carolina

937 Riverwalk Parkway, Ste 203 Rock Hill, South Carolina 29730

P: (803) 659-3671

F: (803) 659-3672

200 S Herlong Ave Suite E, Rock Hill, South Carolina 29730

P: (803) 590-2900

F: (803)-590-2901

485 Tom Hall Street, Ste 101 Fort Mill, South Carolina 29715

P: (803) 228-7972

F: (803) 228-7974

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© 2023 by Oakview Dermatology LLC.

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