Patient Portal & Forms
If there are any questions please contact our staff at firstname.lastname@example.org or 407-481-2620. Please complete your paperwork in either the printable format or in the Patient Portal before your appointment. This will allow us to serve you better and ensure you will see Dr. Judge or a skin care specialist in a timely manner. If you have any questions about anything on these forms, please call us at (407) 481-2620; our staff will be happy to assist you.
To fill out your information manually, click on the links below.
*Note: Please arrive with your completed paperwork 15 minutes before your appointment time to allow our staff to input the information into our system.
- Patient Registration and Medical History
- Office Consent Form
- Notice of Privacy Practices (no signature required)
- Medical Records Release Form for Pickup, Fax, or Mail (Printable)
- Medical Records Release Form for Flash Drive (Printable)
- Payment Form for Medical Records Release (Printable)
- Minor Consent Form (Printable)
- Telemedicine Consent (Printable)
Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.
Login – To instantly update/change your information, click on the “Login” button below.
*Note to Established patients that have been seen after August 1, 2011 – you do not need to fill out the “FORMS” section. We have your medical history/information in our new system. However, please inform our medical staff of any changes/additions to your medications, allergies, surgeries, or past medical history since your last visit.