All forms should be filled out prior to your appointment. Please email the forms to:info@lwderm.comor bring completed forms with you to your appointment.
A waiver of financial responsibility must be submitted for any patient being seen without a required referral in place for their date of service. This form can be emailed to: info@lwderm.com
Please fill out and email this form to: info@lwderm.com prior to your virtual visit. Also, please see the virtual visit section of the website for further instructions regarding virtual visits
Disclaimer: Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed. Please do not include personal medical information in any emails you send to us. No one can diagnose your condition from email or other written communications, and communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.
