At Sutton Dermatology + Aesthetics, we want to make your experience with us as pleasant and as convenient as possible. On this page you will find all the information you need – from patient forms to information about our office – to help you on your way to better skin. You may print, fill out and bring in the following forms to help make the check in process faster and more convenient. All forms are in PDF format. If you do not have a PDF reader, please click here to download the software.

Forms for New Patients

Patient History Form

Acknowledgement of Notice of Privacy Practices (HIPAA)

Insurance Authorization and Medicare Secondary Payer Questionnaire

Permission for Treatment of Minors


Notice of Privacy Practice HIPAA

Deposit Policy Acknowledgement

Product Return Policy

Release of Medical Information

Patient Financial Acknowledgement*

Cancellation Policy

When signing the Patient Financial Acknowledgment form and providing your mobile phone number and email address, you are agreeing to be contacted by Sutton Dermatology + Aesthetics or on behalf of the Sutton Dermatology + Aesthetics.

Schedule Your Appointment

If you’re ready to schedule an appointment with our team of aesthetic experts, book an appointment online or call us at (402) 484-9009 to get started.

Our Services
Dermatology Skin Cancer Aesthetics
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