Patient Information/Medicare Patient Information/Medical History/Office Policy/Privacy Notice and Acknowledgement

As a new patient of Southern Illinois Dermatology, we ask that you complete a registration packet on your first visit. All new patients should arrive approximately 15 minutes early in order to complete the required paperwork. However, you may print the appropriate paperwork (below) and complete it prior to your arrival. Please bring all of your completed forms with you on your visit to Southern Illinois Dermatology. You should have a total of 4 forms.

Use our Patient Portal to:

  • Request appointments
  • Request medication renewals
  • Access your health record
  • Send messages/questions
  • View and pay your statement