Patient’s Paperwork

New Patient Paperwork

The forms needed for your first visit at FRDA are available below.  They may seem a little long, but don’t worry. Most of the questions can be answered very quickly with simple yes or no responses.

Click on each of the hyperlinks, print them, and manually write in the requested information. Then, bring these forms with you to your first appointment.

FRDA Notice of Privacy Practices Acknowledgement ENGLISH

FRDA Notice of Privacy Practices Acknowledgement SPANISH




Other Paperwork

The other forms needed for your visit are shown below. Before your appointment, please print, complete and bring these forms.

Authorization for Medical Records

Consent for treatment of minor

Release of Medical Records

To learn more about the many dermatology services we provide, or to schedule your appointment at our Fort Collins, Loveland, Greeley or Ft. Morgan office, call us today at (970) 673-1155.