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Patient Forms

​Please download, print and fill out the appropriate forms if you are a new patient. 
​Bring the completed forms with you to your appointment. 
​This will minimize your waiting time.

Child Patient Registration
Adult Patient Registration

Patient History Form
Patient Consent Form

Medical & Financial Information Disclosure

Notice of Privacy Practices

Child Privacy Acknowledgement
Adult Privacy Acknowlegement
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1115 South Main Street Bel Air, Maryland 21014 | Phone 410.879.7404
Communications through this website do not constitute a doctor-patient relationship.
Copyright 2019-2020 Bernstein & Robinson Dermatology, P.A. All rights reserved.
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  • Home
  • Forms
  • Dr. Bernstein
  • Dr. Robinson
  • Assistants
  • Products
  • Services
  • FAQs
    • Dermatology Links
  • Make Appointment
    • Patient Portal