Forms

If you are a new patient, please download and complete the Provider Guidelines and Patient Financial Agreement Form and bring it with you to your first visit. 

If you are a new patient and have an appointment for a Medical Consultation, please download and complete the Patient Registration and Health History Form.

Your completion and timely submission of these forms will help Dr. Lamothe assist you in the most efficient manner and make best use of your time during your first visit at Naturopathic Dermatology.

If you would like Dr. Lamothe to review any of your medical records please bring them with you to your visit. The Authorization to Release Medical Records or Health Information form can be downloaded for this purpose.

To learn more about how medical information about you may be used and disclosed and how you can get access to this information, please download The Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Policy Practices form.