Patient Forms

Please print out the following forms, fill them out and bring them with you the day of your appointment:

Patient Information and Medical History(pdf) – please complete

Mohs Consent Form(pdf) – please read prior to your appointment, but TO BE SIGNED AT YOUR APPOINTMENT

Insurance Billing for Mohs/Excision(pdf) – please sign

Review the HIPAA policy below, then print and complete the financial policy form and bring it with you the day of your appointment:

(pdf) – please review

(pdf) – please review

Day of Appointment

Please print out the following forms, fill them out and bring them with you the day of your appointment:

For Your Review

Post-Op Instructions

Dr. Hendi is a board certified dermatologist and skin cancer specialist in the Washington D.C. area. He is fellowship trained in Mohs surgery, which is considered the gold standard skin cancer treatment. Our practice is located in Chevy Chase and accessible to patients in Maryland ( i.e. Bethesda, Rockville, Silver Spring, Gaithersburg, Greenbelt, Germantown, Olney, Columbia, Frederick), Washington DC, and Northern Virginia (Fairfax, Arlington, Alexandria, Annandale, Falls Church, Great Falls, Merrifield, Reston, Tysons Corner, Vienna, Springfield, Oakton).

Designed and Hosted by Digital Pure, LLC
Close Menu