Patients visiting Poole Dermatology, The Laser Center of New Orleans for the first time are required to complete certain forms prior to their scheduled appointment. These forms pertain to our office policies, insurance, and other procedures; as well as, patient information, medical history and how your medical records and other information will be handled (HIPAA). You can save time by completing these forms online (highlight/hypertext link) or printing out and bringing these completed forms to our office when you come to your appointment.

The forms below can be completed online and will be emailed to our front desk receptionist upon clicking the submit button at the bottom of each form.

You must fill out and submit all 6 forms in order for us to create and process your patient record:

Or you may download these forms in pdf format:

 Referral Source Sheet

 Patient Registration Form

 Patient Medical History

 Secured Credit Card Policy

 Understanding your Insurance and Claims Processing

 Gulf South Pharmacy Financial Disclosure

 Pre-Operative Surgical Instructions

Descarga En Español:

 Hoja de Referencia Fuente
 Formulario de Registro de Pacientes
 Historia de la Medicina