Forms

Southeast Dermatology now offers a patient portal to update and access your medical information.  We suggest that you update this information before each visit to save time at your actual visit.  You may call our office to request your username and password. 

A link to the portal is located on the upper right of each page in this web site.  Click this Patient Portal button, or copy and paste the following address to log on:

southeastdermatology.ema.md

Once you enter the portal using your username and password, you will arrive at the Patient Info page.  Here you can update your medical information before each visit.  Please select “Reset Password” at the top right of the screen during your first visit to the portal and reset your password.

Contact info: The information in this section can only be updated by our office. Please let us know by phone or during your appointment if you have changes to information in this section.  Do not make changes to this information on the portal site.

Insurance and Pharmacy:  Please let us know by phone or at your appointment if your insurance changes.  Select "Pharmacy Search" and enter your pharmacy's name and zip code.  Select your pharmacy.

Medications: Click "Mark No Medications" or begin entering your medications under "Add New Medication."  Please enter the drug name, dosage, and frequency.  After adding all your medications, press "Save and Continue." 

Allergies: Click "Mark No Known Allergies" or begin entering your allergies and reactions under "Add New Allergy."  After adding all your allergies, press "Save and Continue."

Past Medical History: Check appropriate boxes; disregard Pediatric History.  Press "Save and Continue."

Skin Disease History: Check appropriate boxes.  Press "Save and Continue."

Social History: Please fill out the smoking section and complete any other appropriate information.  Press "Save and Continue."

Family History: Check appropriate boxes.  Press "Save and Continue."

That completes your portal information entry!  You can update this information anytime.  We look forward to seeing you.

You may also review the following items to further prepare you for your visit. 

  • Notice of Privacy Practices  Please review our Notice of Privacy Practices.  You do NOT need to sign or print this link.
  • Privacy Practice Consent and Financial Statement  You will be asked to sign this form upon checking in for your appointment.
  • Patient Satisfaction Survey  How are we doing? This form is available in our office, or you may print and complete it at any time. We are always working to ensure you have the best possible care at Southeast Dermatology. Thank you for any suggestions and feed back!