Patient Forms

Total Patient Care, llc and Skin First website now available. We are proud to announce our website for your convenience

Total Patient Care’s new ChartMaker (r) Patient Portal. This on-line tool gives you the flexibility to access your health information and other resources at your leisure – any time of the day and from any location

Our Goal is to provide the Best Health Care to all of our Patients. To optimize this care, we ask that when you receive medical care or diagnostic testing outside of our office, you either…………

New Jersey Department Of Health – Vaccination Preventable Disease Program. New Jersey Immunization Information System (NJIIS) – Consent to Participate (IMM-32 JUL 12)

Patient Information form 2016

Policy for Unresolved Patient – Pay Balances. We reserve the right to add a Collection Fee of $25.00 to the Patient’s Account if Past Due 60 days or more and sent out to Our Collection Agency

“No Show” and Cancellation Policy. We reserve the right to charge $50.00 after a patient has four (4) No-Shows (or two 30 minute appointments) and or cancellations not giving 24-Hour Notice

New Patient Waiver

Notice of Privacy Practices

Patient Phone Consent Form

Patient Physical and History Form