By the Templateez Team · Licensed Attorney · June 2026

Dermatology Patient Intake Forms: What Every Practice Needs to Capture

Dermatology intake is unlike any other medical specialty. A patient might walk in for a suspicious mole, a cosmetic Botox consultation, a patch-test workup for contact dermatitis, or a follow-up on a biologic for psoriasis. Each of those visits triggers different clinical questions, different billing pathways, and different consent requirements. A generic medical intake form cannot handle that range, and a form designed for another specialty will miss the questions that matter most in derm.

The result of using the wrong form is predictable: the provider spends the first five minutes of every visit asking questions that should have been answered in the waiting room. Sun exposure history, prior skin cancer, current topical regimens, photosensitizing medications, cosmetic procedure history—none of these appear on a standard medical intake template. When they are missing, the clinical encounter starts behind.

This guide covers what a dermatology intake form should include, how to structure it so the information is useful before the patient reaches the exam room, and how to handle the billing and compliance details that dermatology practices specifically need to get right.

Why dermatology intake is different

Three characteristics set dermatology apart from other specialties when it comes to intake documentation.

The skin has its own history. Unlike a cardiology or orthopedic intake, dermatology requires a detailed history of the organ itself—prior skin cancers, sunburn history, tanning bed use, reactions to topical products, and a family history of melanoma or autoimmune skin conditions. This information does not appear on any general medical intake form because no other specialty needs it at this level of detail.

Cosmetic and medical visits coexist. Many dermatology practices see both medical patients (acne, eczema, psoriasis, skin cancer screening) and cosmetic patients (Botox, fillers, laser resurfacing, chemical peels). Practices that have expanded into full aesthetic services — injectables, body contouring, medical-grade peels — need an even more detailed intake that captures Fitzpatrick typing, treatment-specific screening, and procedure-specific consent (see our medical spa intake guide). These visits bill differently, require different consent documentation, and in some states trigger different regulatory requirements. The intake form must distinguish between the two from the outset so the front desk, billing team, and provider all know which track the visit follows.

Allergies matter more. In dermatology, the allergy history goes beyond drug allergies. Allergies to latex, adhesive tape, fragrances, preservatives (such as formaldehyde releasers or methylisothiazolinone), and nickel are clinically significant for patch testing, wound care, and product recommendations. A derm-specific intake form captures these; a generic one does not.

Medical history: what dermatology specifically needs

Skin cancer history

Every dermatology intake form should ask about personal and family history of skin cancer, broken out by type: basal cell carcinoma, squamous cell carcinoma, and melanoma. The form should also capture the location and approximate year of any prior skin cancers, whether they were treated surgically (excision, Mohs) or with other methods (cryotherapy, topical chemotherapy), and whether the patient is currently under surveillance by another provider. Family history of melanoma in a first-degree relative changes the screening interval and the urgency of any suspicious lesion.

Autoimmune and inflammatory conditions

Psoriasis, eczema, vitiligo, alopecia areata, lupus, dermatomyositis, scleroderma—these conditions are often the reason for the visit, but they also affect treatment decisions for unrelated complaints. A patient with lupus needs different sun-protection counseling. A patient on a biologic for psoriasis has a different risk profile for wound healing. The intake form should include a check-all-that-apply grid for these conditions rather than relying on the patient to volunteer the information in a free-text field.

Current medications

All intake forms ask about medications, but dermatology needs to flag specific categories that directly affect care. These include:

• Isotretinoin (Accutane) — current or recent use affects procedural decisions, lab monitoring requirements, and pregnancy screening protocols
• Immunosuppressants — methotrexate, cyclosporine, mycophenolate, and biologics (adalimumab, secukinumab, dupilumab) change the infection risk profile and influence procedural planning
• Blood thinners — warfarin, apixaban, clopidogrel affect biopsy and excision planning; the provider needs to know before scheduling any procedure
• Photosensitizing drugs — tetracyclines (doxycycline, minocycline), certain diuretics (hydrochlorothiazide), and some NSAIDs increase UV sensitivity, which is directly relevant to both sun-exposure counseling and phototherapy decisions
• Topical prescriptions — current retinoids, corticosteroids, calcineurin inhibitors, and any compounded topicals already in use

The form should ask for medications both as a free-text list and as a targeted checkbox section for these high-impact categories. Patients reliably disclose more when they see the specific drug names listed.

Skin concern documentation

The chief complaint section of a dermatology intake form needs more structure than a single text box. A well-designed form captures:

• Location — where on the body the concern is (a body diagram with checkboxes or a location dropdown is more useful than free text)
• Duration — how long the patient has had the issue (days, weeks, months, years)
• Change over time — is it growing, spreading, changing color, or becoming symptomatic (itching, bleeding, pain)
• Prior treatments — what the patient has already tried, including over-the-counter products, prescriptions from other providers, and home remedies
• Triggers — seasonal patterns, product exposure, stress, sun exposure, dietary factors

This structured approach saves significant exam-room time. When the provider walks in, they already know the patient has had a growing dark spot on the left forearm for three months that bleeds occasionally and has not responded to a steroid cream prescribed by the PCP. That is a fundamentally different starting point than reading "skin spot" in a chief complaint box.

Sun exposure and tanning history

No other specialty asks about sun exposure in the depth that dermatology requires. The intake form should capture:

• Outdoor occupation or hobbies — construction workers, farmers, lifeguards, golfers, and runners have materially different cumulative UV exposure than office workers
• Sunburn history — number of blistering sunburns before age 18 (a known melanoma risk factor), and frequency of sunburns in adulthood
• Tanning bed use — ever used, current use, frequency, and duration of use; indoor tanning is an independent risk factor for melanoma and is particularly relevant for younger patients
• Sunscreen use — frequency (daily, only at the beach, never) and SPF level; this informs counseling priorities
• Skin type — Fitzpatrick scale (always burns/never tans through never burns/deeply pigmented) helps the provider assess baseline UV risk and guides phototherapy dosing

This section is not academic. A patient with a history of 10+ blistering sunburns and five years of tanning bed use in their twenties is in a fundamentally different risk category for melanoma screening than a patient with no such history. Knowing that before the exam changes the thoroughness of the skin check and the aggressiveness of the surveillance recommendation.

Cosmetic vs. medical visit routing

This is a billing and compliance issue as much as a clinical one. The intake form should include a clear question: "What is the primary reason for today's visit?" with options that map to medical vs. cosmetic billing tracks. Medical examples include skin cancer screening, rash evaluation, acne treatment, psoriasis management, and mole checks. Cosmetic examples include Botox, dermal fillers, laser treatment, chemical peels, and scar revision.

Why this matters on the intake form rather than later in the encounter: if a patient is routed as a medical visit but the visit turns out to be purely cosmetic, billing the patient's insurance creates a compliance problem. If a patient is routed as cosmetic but the provider identifies a medical issue during the exam, the billing needs to reflect both. The earlier the distinction is made, the fewer billing corrections are needed downstream.

Some practices use a dual-track form: one section for medical visits and one for cosmetic. Others use a single form with a routing question at the top. Either approach works as long as the answer to "medical, cosmetic, or both" is captured before the patient reaches the exam room.

Allergy section: beyond drug allergies

In dermatology, the allergy section needs its own expanded treatment. Standard drug allergies (penicillin, sulfa, codeine) are important, but so are:

• Latex — affects glove choice during procedures and the selection of adhesive bandages
• Adhesive tape and bandage adhesives — relevant for wound care after biopsies and excisions
• Fragrances and preservatives — critical for patch-test interpretation and product recommendations; patients with known fragrance sensitivity are more likely to have contact dermatitis
• Nickel and metals — the most common contact allergen; relevant for patch testing and for any procedure involving metallic instruments or implants
• Topical anesthetics — lidocaine and other local anesthetics used for biopsies and excisions; a true allergy (versus a vasovagal response) changes the procedural approach

A check-all-that-apply grid for these categories, with a free-text field for additional allergies, captures information that a generic "list your allergies" box consistently misses.

Photo consent for clinical photography

Clinical photography is standard practice in dermatology. Before-and-after images for cosmetic procedures, baseline photos for mole monitoring, wound-healing documentation, and teledermatology consultations all require photographic records. The intake form (or the accompanying patient questionnaire) should capture the patient's consent for:

• Clinical record photography — images stored in the patient's chart for treatment tracking
• Teledermatology — images shared with consulting dermatologists or pathologists via secure platforms
• Educational or publication use — de-identified images used for medical education, conference presentations, or journal publication (this should be a separate opt-in, not bundled with clinical consent)

Photo consent is a HIPAA issue. Clinical photographs are protected health information. The consent should specify how images will be stored, who has access, and whether the patient can revoke consent. A well-designed questionnaire captures this at intake so the provider does not have to interrupt the exam to obtain permission before taking a baseline photo.

Insurance, referral capture, and prior authorization

Many dermatology visits require a referral from a primary care provider, particularly for HMO plans. The intake form should capture the referring provider's name, practice, phone number, and the referral authorization number. Without this information on the form, the front desk has to chase it down by phone—often after the visit has already taken place, which creates billing delays.

For patients on biologic medications or those who need procedures beyond a standard office visit (Mohs surgery, phototherapy, laser treatment), prior authorization is increasingly required. The intake form should include a section for the front desk to note prior authorization status so the provider knows at the start of the visit whether the planned treatment is approved or whether a step-therapy requirement or formulary restriction applies.

HIPAA compliance in dermatology intake

Dermatology practices face the same HIPAA requirements as any healthcare provider, with the additional complexity of clinical photography. Key compliance points for the intake form include using the minimum necessary standard—collecting only the information needed for treatment, payment, and operations. Every page of both the intake form and patient questionnaire should carry a HIPAA footer. The Notice of Privacy Practices acknowledgment belongs on the patient questionnaire (not the internal intake form), and photo consent should be documented separately from general treatment consent.

Fillable PDF intake forms offer a HIPAA advantage over paper: they are easier to store securely, search, and produce in response to patient access requests. They are also easier to update when clinical guidelines or regulatory requirements change.

Building an effective dermatology intake form

The sections above translate into a form structure that looks like this:

1. Patient demographics — name, date of birth, contact information, company (if applicable), emergency contact, referring provider
2. Insurance and referral — primary and secondary insurance, referral authorization number, prior authorization status
3. Visit type — medical, cosmetic, or both (routing question for billing)
4. Medical history — conditions checklist with dermatology-specific entries (skin cancer types, autoimmune skin conditions, photosensitivity disorders)
5. Medications — general list plus flagged categories (isotretinoin, biologics, blood thinners, photosensitizers, topicals)
6. Allergy section — drug allergies plus latex, adhesives, fragrances, preservatives, metals, topical anesthetics
7. Skin concern — location, duration, changes, prior treatments, triggers
8. Sun exposure and tanning history — occupation, sunburn history, tanning bed use, sunscreen habits, skin type
9. Photo consent — clinical photography, teledermatology, educational use (on the questionnaire)
10. Provider notes — clinical impressions, treatment plan, follow-up scheduling (on the intake form only)

The Templateez Dermatology Intake Form and Patient Questionnaire follows this structure. The intake form captures the clinical and administrative information the practice needs internally. The patient questionnaire captures the patient-facing fields plus HIPAA acknowledgment, photo consent, and signature blocks. Both are fillable PDFs with check-all-that-apply grids, tabbed fields, and HIPAA footers on every page.

If your practice spans multiple specialties, the Healthcare Bundle includes 21 specialty-specific intake form and questionnaire sets—dermatology, general medical, pediatrics, physical therapy, mental health, and more—at 40% off individual pricing.