Patient Resources and Forms
Find resources, links, and forms to assist you with your visit to Dermatology Boutique.
Monday 9 – 5
Tuesday 9 – 5
Wednesday 9 – 5
Thursday 9 – 3
Friday 9 – 5
Open select Saturdays
- Patient Registration Packet
- 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.
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.
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.
Instructions for your Telehealth appointment with Dr. Golomb.
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.