Academic Dermatology of Nevada: Home 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name at the top of the form. This is essential for identifying your records.
3. Fill in the 'Date of Visit', 'Date of Birth', and 'Age' fields accurately to ensure proper scheduling and medical history tracking.
4. Select your gender by marking either 'M' or 'F'.
5. In the 'Reason for dermatology visit?' section, provide a brief description of your concerns or symptoms.
6. For medical conditions, indicate any relevant issues by writing 'P' for past problems and 'C' for current ones. Use 'Other' if necessary.
7. List any drug allergies and reactions, as well as current medications. If none, simply write 'None'.
8. Complete the family history section by indicating any hereditary conditions among blood relatives.
9. Provide details about your social history, including tobacco and alcohol use, as well as marital status.
10. Finally, review all entries for accuracy before submitting the form through our platform.

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