patient resources

Patient Forms
The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

For Pediatric Patients Only

» Permission to Treat Unaccompanied Minor

For Existing Patients Only

» Medical Records Release/ Request

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Patient Testimonials
Dr. Derick and her staff are amazing! They take the time to answer any questions I may have and they explain all the procedures clearly. I am not a big fan of needles, but for some reason, the needles are not as scary at Dr. Derick's office. I love the way I look after an office visit, which makes me feel great! I will continue to recommend all my friends to Derick Dermatology.
Pam K. - Barrington Hills, IL