New Patient Forms

To expedite the admissions process, please follow the instructions from the automated email or text that you will receive a few days prior to your appointment.  If you cannot do that,  then please fill out the patient and medical information on the patient portal.  Follow the link here:

Dermsurgery Associates P.A.: LandingPage

You will be able to fill out our online form, print out your completed forms for your records and submit the files to us securely.  Verification of identification, insurance and medical history will be conducted prior to your appointment. We look forward to meeting you.

To consent to a video conference for a virtual consultation with our providers, please complete this form: 

Telehealth Video Conferencing Form (PDF)

New Patient Form – Dr. Kronberg Patients (PDF)
Telehealth Video Conferencing Form (PDF)

Note to Managed Health Care Participants

As a Managed Health Care patient it is YOUR RESPONSIBILITY to identify yourself as a PPO HMO or POS patient to our patient representatives EACH TIME you visit our office. If your POS or HMO plan requires  you to obtain pre-authorization from your primary care physician or patient advocate, please provide our office with this information prior to your visit with the doctor, in order to obtain the highest level of benefits. If you fail to obtain prior authorization as directed by your plan you will be responsible for payment at the time services are rendered.

You will be asked to authorize payment of insurance benefits paid directly to DermSurgery Associates for any services furnished.  We will ask you allow us to release information to Health Care Financing Administration and its agents, Medicare Champus, or any commercial insurance carrier covered by insurance or prepayment programs.