Please fill out these forms and bring them with you when you come for your appointment.
As you know, email is not secure and has a number of risks that you should think about. Your use of email is an acknowledgment of this insecurity and your acceptance of the risk. If you do not want to email your forms, you may fax them to the office at (704) 295-0005 or mail them to 2615 East 7th Street, Charlotte, NC 28204.
Our office is now using the Patient Portal. All patients should update and review their patient portal one week prior to their appointment. It is not necessary to complete paper versions of these forms unless otherwise instructed.
It is not necessary to complete paper versions of these forms unless otherwise instructed as you will fill these out on the Patient Portal.
- Text Consent Form
- Email Consent
- Surgery During COVID Patient Authorization and Consent Form
- In Office Visit During COVID Patient Authorization and Consent Form
Online Patient Portal - Please Complete the information under the My Health tab. This can be found from the dropdown menu in the upper left corner if viewing from your phone or the My Health tab if viewing on a computer.
To access the patient portal, click on carolinaskin.ema.md
Please log in using the credentials that were emailed to you. Please activate your portal within 72 hours of receiving your login information. Please check SPAM folder if you do not receive the email. If this is your first time logging into the portal, your Username will be your email and you will then be prompted to set your own password.
Forms to review before your appointment:
Please review this form before your first appointment. You will sign for this via electronic signature while present at the office.
Please review the following forms before your first appointment. You will sign for both of these forms on the Registration Form (see above).
Please review the appropriate form below before your surgery appointment, sign at the bottom of the page, and bring to your appointment.
- What to Expect with Mohs Surgery
- What to Expect with an Excision
- What to Expect with a Staged Excision ("Slow Mohs")
Medical Record Request Form
If you need to request a copy of your Medical Records for transition of care or other purposes, please complete the Standard Authorization of Use & Disclosure of PHI Form and fax or mail back to our office so we may fulfill your request.