Patient Forms

Submit patient forms online, or print and complete forms before your visit.

Online Medical Forms Submission

Grafton Dermatology and Cosmetic Surgery offers patients the option to submit medical forms online. To use this feature you must have a security code provided by the office. If you do not have a security code, contact the office nearest you to request one. 

>> Register Now to use online forms submission. (Security Code provided by office is required).

>> Log In to the online forms submission system

Online Appointment Request Form

Patients visiting Grafton Dermatology and Cosmetic Surgery for the first time will be required to complete certain forms pertaining to our office policies, insurance, and other procedures; as well as, medical history and how your medical records and other information will be handled (HIPAA).

These forms will be provided to you when you arrive at our office. However, you may save time by bringing these completed forms to our office when you come to your appointment. You may also submit your forms online as mentioned above.

Manual Download & Printing of Forms

Adobe Acrobat Reader must be installed on your computer to open these forms. You may download the program for free here:

Medicare Patient Registration Form >> download medicare form
Patient Information Sheet >> download patient information


About Us

Under the direction of Dr. Lee Grafton, Dr. Tamela Charbonnet and Dr. Kristal Guidroz, Tricia Petrella, board certified esthetician, and Taylor Zeringue, board certified cosmetologist will provide a complete skin care program consisting of in-office Medical Facials, HydraFacial, Micro Peels, Laser Hair Removal, IPL Treatments, make-up consultations using Glo Mineral Cosmetics.