Please fill out the Patient Registration. We prefer it to be submitted electronically; however depending on the accessibility of your personal computer, you may need to print the form and submit the form in person.

Please update your Preferred and Permitted Contact Information if it has not been done within the last year.

Patient Form
Patient Registration Form
Patient Form
Preferred & Permitted Form

Send us a message


    Contact Us
    Phone:330-535-7100
    Email:info@akronderm.com
    Fax: 330-535-2600
    Address: 566 White Pond Drive, Akron OH 44320