Bakal Dermatology Patient Forms

Patient Forms.

These patient forms are included for your convenience and may be viewed / printed with the latest version of Adobe Reader.

Office Hours & Contact

Email us at:

FrontDesk@bakalderm.com
Billing@bakalderm.com
Nurse@bakalderm.com

These email addresses are not secure or HIPAA compliant. Submitting any patient information or sensitive information should be avoided. Do not use these email addresses to address any medical concerns or for any appointment scheduling requests.

Established patients may use
their secure patient portal at bakaldermatology.ema.md
to address any medical concerns, prescription requests, billing questions or for any appointment scheduling requests.

If you do not have patient portal access, please contact the office directly at (847) 882-9300 to speak to a member of our office staff to address your concerns.

Patient Forms.

Patient Registration Form

Medical Information Form

Records Release Form
...

Notice of Privacy Policy
...

Office Hours & Contact

Patient Forms.

Patient Registration Form

Medical Information Form

Records Release Form...

Notice of Privacy Policy...

Office Hours & Contact

Records Release Form
...

Notice of Privacy Policy
...