PATIENT INFORMATION - Pinnacle Dermatology
No, I do not want my skin checked for skin cancer. (Decline a Full Body Exam) Social History ; Smoking Status (please choose one): ... Nose, Throat Loss of hearing, trouble swallowing, nosebleeds, hoarseness, ... earache, nasal polyps, ear ringing Eyes Visual loss or change, trauma, contacts, cataracts, blurred vision, glaucoma Respiratory ...
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PATIENT INFORMATION
pinnacleskin.comSep 15, 2021 · Pinnacle Dermatology, SC Revised Dec. 2019 Page 1 of 9. Patient Information ... Hip (Right, Left, Bilateral) Joint Replacement: Knee (Right, Left, Bilateral) ... remaining balance only if patient does not qualify for patient financing solutions. Returned Checks: Pinnacle Dermatology, SC will charge a $25 fee for any returned checks.
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