Patient Forms

We look forward to taking great care of you.

Patient Forms and Resources

If you prefer not to use the electronic Patient Portal, you may download and complete selected forms by hand and return them to us via email, fax, or in person.

Patient Portal Guide
Preparing for Surgery (Preoperative Instructions)
After Surgery
Medical History Form
Financial and Privacy Policy Acknowledgement
Release of Medical Records
Privacy Practices
Non-Discrimination Policy

Information You Can Trust

Learn About Skin Cancer

Skin Cancer Support

See What Our Clients Are Saying

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I wanted to thank you and your staff for taking such good care of me when I visited the surgery center. I was happy to be treated so kindly and really appreciate that your nurses went out of their way to make me comfortable and help accommodate me with my modesty / religious preferences. Thank you.

—A
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Just a brief note to express my satisfaction with the outcome of the surgery thus far. I appreciated you taking time out of your busy schedule to answer my questions. Also, I want to compliment your staff because they're so courteous whenever I call and they're so helpful. I recommended you highly to a friend who is now considering surgery on her face. She sees a doctor at UK but I said she should consider using your services. In short, I'm glad I put my face in your hands.

—CS
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Thank you for the opportunity to spend time in your practice learning about Mohs surgery and more particularly the art of reconstruction. I sincerely appreciate that you tailored your teaching to my future plans. You are the only professor to have done that so far. This week has given me a great deal of insight into future standards for appropriate skin cancer treatment and management. I look forward to a day when I will be honored to call you a colleague.

—MN, Medical Student
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Three days have passed since your removal of the cancer from my face.  The pain from the surgery has been light and tolerable.  There has been no need for pills to relieve this pain.  There are no signs of bleeding or of swelling.  You mentioned the danger to a nerve which controls the mouth, had the cancer not been removed.  The body is wonderfully made!  It has never occurred to me that there is a mechanism which enables us to open our mouths.

—W
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Thank you, Lindsay, for the warm welcome.  Thank you Blanca and Dr. Dhir for your professionalism and skills, and everyone else involved.

—BG
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You have been absolutely wonderful during this surgery. Thanks so much for your genuine concern and kindness. All of us have been so impressed with your medical expertise, as well as your sincere (and almost forgotten) love for your profession and your patients. You truly are the epitome of a great physician—one to be highly recommended, respected, and recognized. Thanks so much for a job well done and for treating your patients as people, not simply a paycheck.

—RS
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I want to thank you for your superb professionalism, kindness, and huge heart.  You made my experience through the Mohs Surgery bearable, you explained in detail what to expect, and you calmed my racing heart. It took 3 attempts to achieve clear margins and while I was waiting, the staff was nothing but excellent, caring, and reassuring.  You have an A Class Facility.

—NH
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I just wanted to tell you again what a wonderful job you did on my face. As you said it would, each month it gets better and better. If you did not know me, you would never notice it. I am sending this picture so you can see for yourself. Maybe you can put in my file next to the ones that I look beat up in. Ha. Anyway, I really appreciate all of you, not only the great work you do but the care and kindness you showed me. It meant more than you will ever know. Love,

—KL