Fort Mill Dermatology, LLC


Our Doctors
Map & Driving Directions
Our Services
In-Network Insurance Plans
Patient Forms
Dermatology Frequently Asked Questions
Map of this Website





Below are forms that may be used by primary care providers and other doctors office referral departments to refer patients to Fort Mill Dermatology. 

You may use your own forms as long as they contain the same patient information. All three forms below contain the same information.  Choose the format that best suits your needs.  If you have any questions about these forms or the referral process, please call Greg Smith at 803-802-3376 x202.

PDF with form fieldsPDF FORM - This PDF contains form fields that can be filled by typing on the form or copying and pasting information from your practice management system.  The completed form can be printed and then faxed and filed.
Standard PDFSTANDARD PDF - This is a standard form in PDF format for printing. It can then be filled out and faxed.
MS Word DocumentMS WORD DOC - This is a standard form in Word format.  If you prefer Microsoft Word format, use this form.

To provide the best possible coordination of care for your patients, we promptly fax referring providers progress notes on the same day that they are seen in our office. We appreciate your referrals and thank you for allowing us to participate in the care of your patients. 

Top | Home


Copyright 2005-2015 Fort Mill Dermatology, LLC

Reproduction or republication strictly prohibited without prior written permission.

See Legal Notice and Privacy Policy for further information.

Legal Notice | Privacy Policy | Report a Website Problem