Notification Privacy Form


Notification Privacy Form

  • ADVANCED DERMATOLOGY LASER & COSMETIC SURGERY
    1220 Avenue P                                         Brooklyn, NY 11229
    718-375-7546 (Tel)                                     718-376-6475 (Fax)
               CONSENT FOR OUTPATIENT TREATMENT
  • NOTIFICATION PRIVACY FORM

  • As a courtesy to our patients, we remind and/or notify our patients about their upcoming appointments, biopsy results, and/or cosmetic procedures over the phone. If you do not wish for us to disclose this information to your relatives or leave a message on your answering machine, please, let us know how else we may contact you.
    If you do not give us other of notifying you then we are going to use the information given on your PATIENT REGISTRATION FORM in order to contact you.
  • Method of Notification that you prefer

  • Your understanding and cooperation in this matter is sincerely appreciated.


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