Forms
New Patients
Welcome to Manhattan Beach Dermatology! It is our sincerest goal to make your visit as pleasant as possible. If you are a new patient there are forms to fill out to register you as a new patient. For your convenience, you can download the necessary forms, fill them in prior to your visit, and greatly expedite the registration process. We realize that your time is important and strive to make your registration as quick as possible. You can either bring in the forms or fax them to our office (310 802-8150) prior to your appointment. Please don't forget to bring your insurance card and photo identification with you to your appointment.

New Patient Forms (PDF)

New Patient Forms (Word Doc for PC Internet Explorer users)

Notice of Privacy Practices

Existing Patients
Existing Patient Forms (PDF)

Existing Patient Forms (Word Doc for PC Internet Explorer users)
Notice of Privacy Practices


Tips to get the most out of your upcoming dermatology visit:

1. Write down all the questions you have and things you want to discuss during your visit.  Keep in mind that if your list is very long that is fine but it may require more than one visit to address all your skin problems.

2. Prior to your appointment, examine your skin and draw a body diagram marking the location of any spots you would like to have checked.  Have your partner lightly mark spots on your skin that you can't see (i.e., the back) but that he/she may be concerned about.

3. Know your family history -- has anyone in your family had pre-cancerous lesions or skin cancer? What type? Ask before your appointment.

4. Know your own history as well -- have you had skin cancer?  What type and where on your body?  If you have had melanoma, then bring the detailed information (e.g., pathology report) regarding your cancer.

5. Bring a list all of your medications and allergies.  Include aspirin, vitamins, and herbal supplements if you take them.

6. If you have a rash, there are a few things we need to know -- have you changed any of your medications, soaps, moisturizers, cosmetics? Bring in any new products.  Do you have a history of eczema or sensitive skin? Does anyone in your family have a skin disease? What products (both over the counter and doctor prescribed) have you tried?  Bring them with you.  Take a picture of your rash at its worst with your cell phone camera; the rash might be improved by the time of your visit.

7. If your visit is for acne, come prepared.  What products or cosmetics are you currently using? What treatments have you tried? Bring in your skin products or a list of your past and current treatments.  Have you had dryness or burning with previous treatments?

8. Always be honest with us. We will never judge you even if you are an avid tanner or not really using the medication prescribed by your prior doctor. We are here to help, and can only help you best if we know the true story.

9. Think about the timing of your visit -- don't schedule an appointment for a treatment of the face if you have a social engagement, sunny vacation, or important work meeting in the next few days; don't schedule a surgical appointment if you will be travelling, swimming or planning a strenuous athletic endeavor in the next few days.

10. For cosmetic and surgical patients, read the instructions, available on this website, prior to the procedure you have scheduled so that you come prepared having followed the pre-operative instructions and know what to expect afterwards.

2809 N. Sepulveda Blvd
Suite A
Manhattan Beach
CA 90266
P:(310) 802-8180
F:(310) 802-8150

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