Advanced General & Cosmetic Dermatology

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Patient Forms

Please Print and bring, mail, or fax completed forms to Hill Dermatology at: 309 SE Frank Phillips Blvd, Bartlesville, OK 74003. Fax # (918) 214-8887. DO NOT send Patient Forms via email.

Demographic Template
Rev Patient Agreement
Notice of Privacy Practices
Rev Auth for Release
Blank Auth Release

Per HIPAA Regulations, health-sensitive information must not be transmitted via this website or Hill Dermatology email.

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