Streamline Your Visit
Patient Forms
📋 Archived Patient Documents
1️⃣ New Patient Registration Form
Provides general contact information, medical history, allergies, and insurance details.
(PDF format — for reference only)
2️⃣ Medical History Questionnaire
Used to record any previous dermatologic conditions, current medications, and treatment history.
(PDF format — for reference only)
3️⃣ Consent to Treatment & Privacy Acknowledgment (HIPAA)
Outlines patient rights, confidentiality policies, and consent for dermatologic or aesthetic procedures.
(PDF format — for educational purposes only)
4️⃣ Financial & Billing Policy
Describes payment terms, insurance coordination, and self-pay policies previously used by the clinic.
(PDF format — archived reference)
📜 Legal Disclaimer
This page and any downloadable materials are not active medical forms.
They are provided as archived examples of standard dermatology documentation for informational purposes.
Do not attempt to submit or fill out any form via this website — it will not reach a licensed medical provider.
⚖️ Important Note
This page is maintained for historical and educational reference only.
Michigan Skin Clinic has transitioned into MI Health Clinic and no longer collects or processes patient data through this website.
If you were a patient of Michigan Skin Clinic and need medical records or forms, please contact MI Health Clinic directly through their official website: