As a Mohs patient, you will receive a Patient Information Package. Included in this package is an important Health Questionnaire, which you will need to complete and return to us as soon as possible—prior to your scheduled surgery date.

As an alternative to fax or email, you may also submit this form to us online, using our convenient and secure Patient Login portal.

To sign up, please contact our office, and we will assign you a Security Identification Code. Once you login using your User Name (email address) and this code, you will be prompted to create a password. You can then fill out the form and submit the information.

All of your information is kept strictly confidential. Please read through our privacy policy for more information.