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Carrollton Dermatology Associates :: 100 Professional Place :: Carrollton, GA 30117 :: Phone: 770-834-0818 :: Fax: 770-834-5098 :: Email Us

Patient Information form Click to display and print PDF Form


For your Information

CDA HIPPA Notice information form Click to display and print PDF form.


Welcome to Carrollton Dermatology Associates, and thank you for choosing our practice!  We are very happy that we were able to recently schedule you an appointment with one of our providers.  Please let us know if we can be of any assistance.  If you will be unable to keep this appointment, we request a 24 hour notice.

Before your appointment, please print and complete the Patient Registration form. (Located at bottom of page)    Please take time to complete the forms in their entirety.  If an item does not apply to you, you may simply put NA on the blank.  We need to know as much as possible about your medical history so that the doctor can provide you with the best possible care available.

Please remember to bring these forms with you when you come to our office for your appointment.  Please also bring with you your insurance card(s) and your picture I.D.  Due to frequent changes in health care regarding insurance coverage and preventative care, we ask that you contact your insurance company and verify your benefits and whether Dr. Lamb or Dr. Clark is a participating physician with your personal plan before coming in.  If you have coverage with more than one insurance company, please call each company to verify coverage.  As of April 1, 2005 we no longer accept Peachcare or Medicaid as a primary insurance and we apologize for any inconvenience.  

If there is any part of the package that you will need help with, please bring that to our attention upon your arrival.  

Thank you once again for giving us the opportunity to assist you with your healthcare needs.  We look forward to meeting you!

Sincerely,

The Staff of Carrollton Dermatology Associates