• New Patient Registration Form

  • This is a secure form. Upon processing this form you will receive a call from the office to arrange an appointment date and time. You may not be receiving a confirmation phone call if you were previously contacted about your appointment date and time. Please note that online registration forms submitted after 1 p.m. will be processed the next business day. Any forms submitted over the weekend, or holidays will be processed the next business day.

    PLEASE NOTE:

    Fields on this form marked with * are required.

    If you are unsure about an answer to a required field, please insert a question mark "?" to proceed.

    CLICK HERE for a list of Frequently Asked Questions before starting.

  • Damascus Dermatology is open Monday to Friday: 8 AM to 4 PM




  •  -
  •  -
  •  -



  •  -