Dermatology Intake Forms & Patient Questionnaires

Dermatology Intake Is Not a General Medicine Intake

A dermatology practice cannot use a generic medical intake form and expect it to capture the information that actually matters in a skin-focused visit. The medication list in dermatology serves a different purpose than in primary care: you are not just looking for drug interactions, you are looking for photosensitizing medications (doxycycline, hydrochlorothiazide, amiodarone) that change how you counsel the patient about sun exposure, immunosuppressants that alter skin cancer risk, and whether the patient has ever taken isotretinoin, which has its own set of mandatory documentation requirements. A dermatology intake must also distinguish between a medical visit and a cosmetic visit at the front door, because the billing, consent, and documentation requirements are entirely different. These fillable PDF dermatology intake forms are HIPAA-compliant and designed specifically for dermatology practices, not adapted from a general medical template.

Skin Cancer Screening and Mole Surveillance

The annual skin check for a patient with 50-plus moles and a first-degree relative who had melanoma is a fundamentally different encounter than a routine skin exam on a patient with no risk factors. The intake must capture personal history of skin cancer (melanoma, basal cell carcinoma, squamous cell carcinoma), the type and location if prior skin cancer was treated, the treatment method (Mohs surgery, excision, radiation, topical chemotherapy), and the date of the last skin check. Family history of melanoma in first-degree relatives significantly elevates risk and changes the surveillance interval. Sun exposure history is not a yes-or-no question: the intake needs to capture childhood sunburn history (blistering sunburns before age 18 are a major melanoma risk factor), tanning bed use (duration and frequency), current sun protection habits, outdoor occupation or recreational exposure, and Fitzpatrick skin type. The ABCDE criteria for mole evaluation (asymmetry, border irregularity, color variation, diameter greater than 6mm, and evolving characteristics) should be referenced in the questionnaire so the patient can flag any moles that have recently changed before the full-body exam. Prior biopsy results, including the pathology report details and which laboratory read the slides, need to be captured for continuity of care.

Acne, Isotretinoin, and Regulatory Documentation

Acne patients represent a significant portion of any dermatology practice, and the intake for acne must capture information that goes well beyond "how long have you had breakouts." The intake documents the location and type of acne (comedonal, inflammatory, cystic, nodulocystic), prior treatments and their outcomes (topical retinoids, benzoyl peroxide, topical antibiotics, oral antibiotics, hormonal therapy, spironolactone), and any prescription medications currently in use. For patients who may be candidates for isotretinoin, the intake takes on regulatory significance. The iPLEDGE REMS program requires documentation of pregnancy prevention counseling, two forms of contraception for patients of childbearing potential, baseline laboratory values (pregnancy test, lipid panel, liver function tests, CBC), and monthly compliance verification. A patient's history with isotretinoin from a prior course, including the daily dose, total cumulative dose, duration, side effects experienced, and whether they completed the full course, is critical information that affects whether a second course is appropriate and at what dosing. The intake captures all of this so the provider can determine candidacy before the first prescribing visit.

Chronic Skin Conditions and Biologic Therapy

Patients with psoriasis, eczema (atopic dermatitis), rosacea, hidradenitis suppurativa, and other chronic inflammatory skin conditions require a different depth of intake than acute complaints. The intake must document the age of onset, distribution and severity, prior treatment history (topical corticosteroids by potency class, calcineurin inhibitors, phototherapy type and number of sessions, systemic medications including methotrexate, cyclosporine, and acitretin), and current biologic therapy if applicable. Patients on biologics (adalimumab, secukinumab, ustekinumab, dupilumab, risankizumab) need documentation of their current regimen, injection schedule adherence, baseline tuberculosis screening results, hepatitis B and C status, and any prior biologic failures and the reasons for switching. Psoriatic arthritis screening is a dermatology intake item because up to 30% of psoriasis patients develop joint involvement, and early rheumatology referral changes outcomes. The questionnaire asks about joint pain, stiffness, nail changes (pitting, onycholysis), and scalp involvement, which are clinical indicators that the skin disease may have systemic manifestations requiring coordinated care.

Cosmetic Dermatology and Procedure-Specific Intake

When the visit purpose is cosmetic rather than medical, the intake shifts to capture aesthetic goals, prior cosmetic procedures (neurotoxin injections, dermal fillers, chemical peels, laser treatments, microneedling), adverse reactions to prior procedures, and realistic expectations. Filler complications (vascular occlusion, granulomas, migration) from prior treatments at other practices need documentation because they affect the safety of subsequent injections. Keloid or hypertrophic scarring history determines whether certain procedures are contraindicated. For laser-based treatments, Fitzpatrick skin type is not optional information: higher skin types carry higher risk of post-inflammatory hyperpigmentation and hypopigmentation with certain laser wavelengths, and the intake must document this before any laser procedure is scheduled. Active ingredients in the patient's current skincare routine (retinoids, glycolic acid, hydroquinone, vitamin C serums) can affect healing and treatment timing. The questionnaire captures all of this so the consultation focuses on treatment planning rather than basic history-gathering.

Medication Lists and Allergy Documentation

The dermatology medication list requires specificity that generic intake forms miss. Beyond current prescriptions, the intake needs to capture over-the-counter skincare products, supplements (biotin can interfere with certain lab tests, fish oil affects bleeding time for procedures), and herbal preparations. Drug allergies in dermatology are particularly important for sulfonamide sensitivity (relevant for dapsone), tetracycline class allergies (relevant for the most commonly prescribed oral antibiotics for acne and rosacea), and latex allergy (relevant for examination gloves and procedure equipment). Contact allergy history, including known allergens identified by patch testing, is a dermatology-specific intake item that has no equivalent in general medicine intake forms. A patient with a documented allergy to nickel, fragrance mix, or formaldehyde may need those allergens avoided in prescribed topical medications, and that information must be captured before the first prescription is written.

Our Dermatology Intake Form & Patient Questionnaire set is available for $19.99 (complete set), $14.99 (intake form only), or $9.99 (questionnaire only). Every form is a fillable, HIPAA-compliant PDF that works in any PDF reader and prints cleanly for clipboard use at check-in.