Arizona’s Leading Dermatology Center

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Appointment Forms


New Patient Forms

To save time, new patients may print, fill out, and bring the following forms to their initial appointment. If you are an established patient that has not been seen in over a year please print, fill out, and bring these forms to update your information.

Patient Information
HIPPA
Medical History
Authorization to Release Information
Acknowledgement of Receipt of Privacy Notice

Medical Records Release

Please print and fill out the following form if you would like to have copies of your records transfered from The Skin and Cancer Center of Arizona to another physician, or if you would like to obtain copies for your personal records. You may mail or hand deliver this form to The Skin and Cancer Center of Arizona.

Medical Records Release

Medical Records Request

Please print and fill out the following form if you would like The Skin and Cancer Center of Arizona to obtain copies of your records from another physician. You may mail or hand deliver this form to The Skin and Cancer Center of Arizona.

Medical Records Request

Two Convenient Locations


Skin and Cancer Center of Arizona
725 South Dobson Road, Suite 200
Chandler, Arizona 85224
Tel: 480-899-7546
Fax: 480 899-7599




Skin and Cancer Center of Arizona
21321 E. Ocotillo Rd., Suite 124
Queen Creek, AZ 85142
Tel: 480-899-7546
Fax: 480 899-7599

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