601 Dixie Street, Carrollton, GA 30117 Mon–Fri · 7:00am–5:00pm
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Patient Forms

Authorization for Use or Disclosure of Protected Health Information to DSWG PC

New to West Georgia Dermatology? Use this form to authorize your previous doctor to transfer your medical records to our practice (Dermatology Specialists of West Georgia, P.C.).

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Download the PDF

Prefer to handle it another way? Complete this form through the Patient Portal, or call (770) 838-9333 and our front desk will have a copy ready at your visit.

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