{"id":1291,"date":"2020-01-16T13:19:02","date_gmt":"2020-01-16T13:19:02","guid":{"rendered":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/?page_id=1291"},"modified":"2026-03-06T18:08:14","modified_gmt":"2026-03-06T18:08:14","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/patient-resources\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling prim-care1-home-sec1\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:30px;--awb-padding-bottom:30px;--awb-background-image:linear-gradient(180deg, rgba(255,255,255,0) 35%,#ffffff 100%),url(https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2020\/07\/Bio-Page-Background-Image.png);;--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-animated\" style=\"--awb-padding-top:15px;--awb-padding-bottom:15px;--awb-bg-size:cover;\" data-animationType=\"fadeInLeft\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-1\"><h1 style=\"margin-bottom: 0px; text-align: center;\"><span style=\"color: #019da9;\">New Patient Forms<\/span><\/h1>\n<\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling prim-care1-home-sec2\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:100px;--awb-padding-bottom:20px;--awb-background-color:rgba(255,255,255,0);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-animated\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;\" data-animationType=\"fadeInLeft\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-2\"><p>Visiting the office for the first time? Then please follow the two-step process below to make your first visit a breeze!<\/p>\n<p class=\"prim-care1-p-20\" style=\"margin-bottom: 40px;\">Step 1: Complete your New Patient Forms<\/p>\n<p>Please 1) open and print the <a href=\"\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/03\/Miami-Dermatology-and-Cosmetics-New-Patient-Intake-Packet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">New Patient Forms<\/a>, and then 2) complete them and bring them with you to your first appointment. These forms request basic information that the office needs to create your account. You will need Adobe Reader to view the forms. If you don\u2019t have this program, <a href=\"https:\/\/acrobat.adobe.com\/us\/en\/acrobat\/pdf-reader.html\" target=\"_blank\" rel=\"noopener noreferrer\">download it here<\/a> for free.<\/p>\n<ul>\n<li><a href=\"\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/03\/Miami-Dermatology-and-Cosmetics-New-Patient-Intake-Packet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">New Patient Forms<\/a><\/li>\n<li><a href=\"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/03\/Notice-of-Privacy-Practice-QR-Code.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Notice of Privacy Practices<\/a><\/li>\n<\/ul>\n<p class=\"prim-care1-p-20\" style=\"margin-bottom: 40px;\">Step 2: Complete your Medical History Questionnaire<\/p>\n<p>Please submit your Medical History Questionnaire online before your first appointment by going to your <a href=\"https:\/\/www.mypatientvisit.com\/#\/login?practiceID=VMAYEA\">Patient Portal<\/a>.<br \/>If you are visiting the <a href=\"https:\/\/www.mypatientvisit.com\/#\/login?practiceID=VMAYEA\">Patient Portal<\/a> for the first time, and do not already have a username and password, then you will need to Create an Account. To Create an Account, you will need:<\/p>\n<ul>\n<li>Your First Name<\/li>\n<li>Your Last Name<\/li>\n<li>Your Date of Birth<\/li>\n<li>Your home\u00a0address Zip Code<\/li>\n<li>Your Patient Portal Security Code (given to you\u00a0by the office when you made your appointment), and<\/li>\n<li>Our practice ID (VMAYEA).<\/li>\n<\/ul>\n<p>All of this information will need to exactly match what the office has on file for you. Once logged in, go to myDocuments -&gt; Forms -&gt; Dermatology Online History -&gt; Start Form.<br \/>If you have difficulty logging in, please contact the office!<\/p>\n<\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling prim-care1-home-sec6\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-bottom:140px;--awb-background-image:url(&quot;https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2020\/07\/patient-feedback.jpg&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last testimonials-sep-row\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:60px;margin-bottom:60px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-blend:overlay;--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-3\"><h2 style=\"text-align: center; margin-bottom: 0.7em;\">Patient Feedback<\/h2>\n<\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:15px;margin-bottom:15px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-testimonials clean awb-speech-bubble-show fusion-testimonials-1 testimonials-sec\" style=\"--awb-textcolor:#909195;--awb-backgroundcolor:rgba(246,246,246,0);--awb-testimonial-border-style:solid;--awb-testimonial-border-color:var(--awb-color3);--awb-navigation-size:12px;--awb-border-top-left-radius:0px;--awb-border-top-right-radius:0px;--awb-border-bottom-left-radius:0px;--awb-border-bottom-right-radius:0px;--testimonial-border-width-top:0px;--testimonial-border-width-right:0px;--testimonial-border-width-bottom:0px;--testimonial-border-width-left:0px;\" data-random=\"0\" data-speed=\"20000\"><div class=\"reviews\"><div class=\"review active-testimonial avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cGreat visit. The office was clean and the doctor was polite. He answered all my questions and did not rush through the appointment.\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Veronica S.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cHe was very polite and took the time to explain everything. The office and treatment rooms were clean.\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Kensha W.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cGreat doctors. The office is very fast with appointments and the wait time was short. Very helpful staff.\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Carlos M.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cThe doctor is always very thorough in his examination and doesn\u2019t try to push unnecessary treatments. Very professional.\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Oscar M.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cVery observant, does not rush and explains clearly. I\u2019m telling my husband he should go there!\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Linda L.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cThorough examination and efficient removal of possible skin problem without any pain. Very satisfied.\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Robert A.<\/strong><\/span><\/div><\/div><div class=\"review avatar-above no-avatar\"><blockquote class=\"testimonials-shortcode-blockquote\"><div class=\"awb-quote\"><div class=\"awb-quote-content\">\n<p style=\"text-align: center;\">\u201cA Professional Medical Office that focuses on Patient\u2019s Wellness. Every Visit is Positive. I\u2019ve been returning for approximately 10 years!\u201d<\/p>\n<\/div><\/div><\/blockquote><div class=\"author\"><span class=\"company-name\"><strong>Ella W<\/strong><\/span><\/div><\/div><\/div><div class=\"testimonial-pagination\" id=\"fusion-testimonials-1\"><a href=\"#\" aria-label=\"Testimonial Pagination\"  class=\"activeSlide\"><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><a href=\"#\" aria-label=\"Testimonial Pagination\" ><\/a><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div>\n<\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container has-pattern-background has-mask-background hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-sizes-top:0;--awb-border-sizes-bottom:0;--awb-border-sizes-left:0;--awb-border-sizes-right:0;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:0px;--awb-padding-right:0px;--awb-padding-bottom:0px;--awb-padding-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-padding-top:40px;--awb-padding-left:60px;--awb-padding-left-small:30px;--awb-bg-size:cover;--awb-width-large:66.6666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.88%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-element \" style=\"text-align:left;--awb-max-width:300px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"\/miami-dermatology-and-cosmetics-prime\/\" target=\"_self\" aria-label=\"Miami-Dermatology-Cosmetics-logo\"><img decoding=\"async\" width=\"266\" height=\"67\" src=\"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/02\/Miami-Dermatology-Cosmetics-logo.png\" alt class=\"img-responsive wp-image-1648\" srcset=\"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/02\/Miami-Dermatology-Cosmetics-logo-200x50.png 200w, https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-content\/uploads\/sites\/113\/2026\/02\/Miami-Dermatology-Cosmetics-logo.png 266w\" sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 266px\" \/><\/a><\/span><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_3 1_3 fusion-flex-column d-none\" style=\"--awb-bg-size:cover;--awb-width-large:33.3333333333%;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-end fusion-content-layout-column\"><div class=\"fusion-image-element \" style=\"text-align:left;--awb-max-width:300px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"https:\/\/www.toplinemd.com\/why-topline-md\/\" target=\"_blank\" aria-label=\"TopLine MD-RegisterR_Stacked_Logo_rgb_color\" rel=\"noopener 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\/><\/a><\/span><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1291","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/pages\/1291","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/comments?post=1291"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/pages\/1291\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/miami-dermatology-and-cosmetics-prime\/wp-json\/wp\/v2\/media?parent=1291"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}