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CHERRY CREEK DERMATOLOGY, P.C. J. Michael Maloney, M.D. F.A.A.D. INITIAL PATIENT HEALTH QUESTIONNAIRE Your Name Do you go by a nickname? Date of birth Primary Doctor: Today s Date: Preferred Contact
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How to fill out cherry creek dermatology pc
How to fill out Cherry Creek Dermatology PC:
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Start by visiting the Cherry Creek Dermatology PC website or office. You can access the necessary forms online or pick them up at the reception.
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Fill in your personal information, including your full name, date of birth, address, phone number, and email address. This information is important for communication purposes and ensuring accurate records.
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Provide your medical history, including any previous dermatological conditions, allergies, or chronic diseases. This information helps the healthcare professionals understand your health background and provide suitable treatments.
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Indicate any medications you are currently taking, including over-the-counter drugs, supplements, or herbal remedies. This is crucial as certain medications can interact with dermatological treatments.
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Specify any specific concerns or reasons for your visit. You can briefly describe your skin issues, such as acne, psoriasis, eczema, or suspicious moles or spots. This will help the dermatologist have a better understanding of your needs.
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If you have insurance, provide your insurance details, such as the name of your insurance company, policy number, and any applicable co-pay or deductible information. This enables the clinic to bill your insurance company accurately.
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Lastly, sign and date the form to confirm that the information provided is accurate to the best of your knowledge.
Who needs Cherry Creek Dermatology PC?
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Individuals with various dermatological conditions such as acne, rosacea, eczema, psoriasis, or skin infections may benefit from seeking the services of Cherry Creek Dermatology PC.
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People experiencing hair or nail disorders such as hair loss or brittle nails can also seek professional assistance from Cherry Creek Dermatology PC.
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Those in need of cosmetic or aesthetic procedures like Botox, dermal fillers, laser treatments, or chemical peels can benefit from the specialized services offered by Cherry Creek Dermatology PC.
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In summary, anyone with skin, hair, or nail concerns, from medical conditions to cosmetic needs, can benefit from visiting Cherry Creek Dermatology PC.
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What is cherry creek dermatology pc?
Cherry Creek Dermatology PC is a dermatology practice located in Cherry Creek.
Who is required to file cherry creek dermatology pc?
The owners or operators of Cherry Creek Dermatology PC are required to file.
How to fill out cherry creek dermatology pc?
Cherry Creek Dermatology PC can be filled out by providing all required information about the practice.
What is the purpose of cherry creek dermatology pc?
The purpose of Cherry Creek Dermatology PC is to report important information about the practice.
What information must be reported on cherry creek dermatology pc?
Information such as financial data, ownership details, and operational information must be reported on Cherry Creek Dermatology PC.
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