Piedmont Dermatology
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Patient Forms

We want to ensure your visit is as pleasant and efficient as possible. One way to save time is to bring your completed forms with you to your appointment. We’ve provided these forms for your convenience.

If you have a question concerning any of the forms below, or encounter trouble downloading or printing them, please call us today. All files are downloadable PDFs.

New Patient Form

Medical History Form

HIPAA Form

Permission to Discuss Medical History (English)

Agreement as to Resolution of Concerns

Dr. Ned Gross
Patient Portal Access
Office Address
314 Fairy Street, Suite D
Martinsville, VA 24112
Phone/Appointments
276-666-8439
Physician Hours
Monday: 11 am to 7 pm
Tuesday: 7 am to 7 pm
Wednesday: 7 am to 2 pm
All other days Dr. Gross is available by televisit/telephone. Call office to arrange.
In Office Staff Hours
Monday: 8 am to 7 pm
Tuesday: 7 am to 7 pm
Wednesday: 7 am to 5 pm
Thursday: 8 am to 5 pm
Friday: 8 am to 5 pm
FAX
276-666-8440
Copyright 2018. Piedmont Dermatology.
© 2020 Piedmont Dermatology. All rights reserved.