The Providers and Staff of Advanced Dermatology of the Midlands would like to welcome you to our practice. We are looking forward to meeting you at your upcoming appointment. The following downloads will assist you with the registration process.

Click here for the New Patient Information Form

Click here for the Established Patient Information Form

You can download the above forms to your computer and complete them at your convenience or you can bring them to your visit or fax them to our office at (402) 933-3633.

Please be prepared to provide this information to our office along with your current medical insurance card and your photo identification. If your insurance requires a referral, please bring the referral form with you. If have a specialist co-pay, we will collect that at time of service.

Please arrive 15 minutes prior to your first appointment to allow sufficient time for the registration process. If you would prefer to complete the forms at our office, please arrive 30 minutes prior to your appointment time.