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Patient Forms

To view and download forms, click on the following links:

Medical History and Intake Form

Acknowledgement of Notice of Privacy Practice

Patient Rights and Responsibilities

Release of Information

Office and Payment Policy

Outgoing Records Release

Contact Us for more information

Topeka Location

5120 SW 28th St, Topeka, KS 66614
Phone: (785) 408-5800
Email: info@RicksDerm.com
Hours: Monday-Thursday 7:30am-5pm, Friday 7:30am-4pm

Lawrence Location

Wakarusa Corporate Centre
4910 Corporate Centre Drive, Suite 150, Lawrence, KS 66047

Phone: (785) 730-8770
Email: info@RicksDerm.com
Hours: Monday-Thursday 7:30am-5pm

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