Patient Forms

Our forms are available either as a secure, online form or as a printable form. Please click on the link for the online form needed. You will be directed to our online form to fill out and submit.

If you choose to download and print a form, you will need Adobe Reader to download these forms. Select the form you want to print below, download and print the form. Fill out the form(s) and bring to your visit, fax, or mail these completed forms.

Need Assistance?

We have provided our patient forms for you to easily fill out online, or to download and fill out prior to your visit. Please use the links to access the most current forms. If you have any questions, or need assistance, please use the button below to contact us. 

Medical Records Release

If you would like to request a copy of your medical records, please fill out our online form, or download, print, and complete the below Medical Records Release. You can fax this form to 423-877-1387 or mail this form to:

Susong Dermatology
Attn: Medical Records
2051 Hamill Road, Suite 301
Hixson, TN 37343

Medical Records Release

Please allow 7 business days for us to release your records.

We Care About You

Our patient-first approach and dedication to excellent patient care make us the best dermatology group in the Chattanooga area.  We will work with you to find the best answers for your skin needs and solutions that are right for you.

Board Certified

Dr. C. Rodney Susong is a board-certified dermatologist and fellow of the American Academy of Dermatology. Dr. Susong leads the team of clinicians that work to bring you the best care.

Major Insurances

We accept Medicare, BlueCross BlueSheild, Cigna, United Healthcare, Aetna, CareCredit and all major credit cards. More information about our insurance can be found here.

Proven Results

For more than 35 years, we have remained Chattanooga's premier dermatology group and are proud to call this area our home. We hope that you will entrust us with your family's dermatology care and look forward to meeting you soon

Susong Dermatology provides a full range of services, designed to provide you the knowledge, care, and guidance to beautiful radiant skin. Let us help you find the right approach to achieving the skin you always wanted.


Main Office:
2051 Hamill Road
Suite 301
Hixson, TN 37343

Office Hours

8:00 AM – 5:00 PM – Monday
8:00 AM – 5:00 PM – Tuesday
8:00 AM – 5:00 PM – Wednesday
8:00 AM – 5:00 PM – Thursday
8:00 AM – 3:00 PM – Friday

Phone Numbers

Main Office:
(423) 870-3376 Office
(423) 877-1387 Fax



Request an Appointment by visiting our online appointment request page: