Patient Resources and Forms
Find resources, links, and forms to assist you with your visit to Dermatology Boutique.
Office Hours
Monday 9 – 5
Tuesday 9 – 5
Wednesday 9 – 5
Thursday 9 – 3
Friday 9 – 5
Open select Saturdays
Patient Forms
- Patient Registration Packet You may fill out this document in advance and bring it to your first appointment.
- Release of Medical Information to Dr. Cynthia Golomb
- Notice of Health Information Privacy Practices 4 pages (HIPAA) This document is for the patient to review.
- Acknowledgment of Receipt of Privacy Practices (HIPAA) This one-page document is for the patient to sign. If you book online, you will sign this document online.
Insurance Accepted
This page lists the insurance we currently accept.
No Photography or Recording — to Ensure Patient Privacy
To ensure the privacy of all my patients’ information, I do not allow patients to do video or audio recordings in my office or in exam rooms. This includes digital recordings with smartphones. This protects the privacy of all my patients and staff, in compliance with federal and state privacy laws.
Patient Portal
Print and complete the patient registration form and bring it to your first visit. Once you have booked your first appointment, our system will email you a link to the patient portal. Before your appointment, enter your medical history, current medications and preferred pharmacy into our Patient Portal. Use either the Chrome or Firefox web browser when accessing the patient portal.
Telehealth
Instructions for your Telehealth appointment with Dr. Golomb.
Email Newsletter
Sign up to receive skin care tips and news to improve your health and appearance from Dr. Cynthia Golomb. The newsletter is sent approximately monthly and you can unsubscribe at any time. Get in the know and sign up for emails from Cynthia Golomb, MD.
Additional Resources
Do’s & Don’ts Before and After a Cosmetic Treatment
Questions To Ask Before Cosmetic Procedures
Questions to Ask Your New Dermatologist
