We understand that nobody enjoys completing paperwork, however, there is certain information we need for all our patients and there are notices we are required to give you by law. To streamline the process, you will receive a link with access to your patient portal where you can complete the necessary information online. If you prefer to complete paper forms, you may either arrive 15-20 minutes prior to your appointment time to complete them in the office or you can complete them in advance by downloading and printing them from the options below.

For medical services, please bring your insurance cards, a photo ID, a current medication list, including dosage and frequency, and payment for your copay if applicable, to your appointment.

For cosmetic services, an assessment form must be completed, informed consent given, and payment is required prior to your treatment.

Completed registration and consent forms can either be brought to your visit or submitted prior to your appointment. Release of medical record forms and completed forms may be submitted via:

Mail to:
1903 S 6th St, Ste 3, Brainerd, MN 56401

In person:
1903 S 6th St, Ste 3, Brainerd, MN 56401
415 Barclay Ave, Pine River, MN 56474

Fax to:
218-454-4263

Please complete all forms in this packet for your appointment.

Use this form if you would like to make a change to who is authorized to access your personal health information (PHI).

Please complete all forms in this packet for your child’s appointment.

Use this form to allow someone other than a parent or legal guardian to accompany an established minor patient to appointments.

Use this form to have your medical records sent to Central Minnesota Dermatology from another clinic or facility.

Use this form to have your medical records sent from Central Minnesota Dermatology to another clinic or facility.

Options for returning completed release of information forms can be found at the top of this page.

This form must be completed for each different cosmetic procedure and/or injectable treatment you would like to receive.

This document provides information to assist you with determining your Fitzpatrick skin type number.

This consent must be initialed and signed prior to receiving any dermal filler treatments.

This consent must be initialed and signed prior to receiving any neurotoxin treatments.

This consent must be signed prior to using the Pro-Nox Nitrous Oxide Delivery System.