(703) 310-7400 | Dr. Herbert - Dermatologist in Arlington, VA

(703) 310-7400

Book Online

FDL Dermatology Arlington VA Medical Dermatology

New Patient Paperwork

Step 1: Fill out forms during online booking

Please complete the forms on the “Book Appointment” page before arriving for your appointment as a new patient. Be sure to bring a valid, government issued photo ID. We also ask that you bring a current copy of your insurance card as this will be submitted with any laboratory or pathology specimens.

Additional Forms

Telemedicine Consent Form

Your consent to a telemedicine appointment.

Medical Records Release

This form is used when you would like to request your medical records.

Privacy Policy

This form is used for you to acknowledge our Privacy Policy.

Family and Friends Release

This form is used if you would like to give our office permission to speak to someone other than yourself regarding your personal medical history, office visits, pathology results, etc.

Third Party Release

This form is used when a third party, such as a life insurance company, is requesting your medical records. Please note that there may be a fee associated with releasing your records; this office policy is listed in our new patient paperwork.

Authorization for Disclosure of Protected Health Information
Minor Consent Form