Health Information Form

Online New Patient Forms

Important Information

Please fill all forms out as thoroughly as possible. By initialing or typing your name in the "Signature" and "Initial" text boxes, you are authorizing and giving Susong Dermatology permission to access your personal health information. For assistance with the forms, please contact us at (423)870-3376.

*By clicking the “Submit” button, you are authorizing Susong Dermatology to access your personal information, and health records. Please visit our Privacy Practices page for more information about what information we collect and how we use it.

New Patient 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. 

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