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Dermatology of Central Ohio
161 Clint Drive Suite 100
Pickerington, OH 43147
PHONE: (614) 866-8603
FAX: (614) 866-8699
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PDF Downloads
Please download the PDF file you are looking for by clicking the PDF icon next to the file desription. If you would like to send the files in to the clinic - just print, fill out and mail or fax back to us.

You will need Adobe Acrobat Reader to view and print these documents. If you are having problems viewing these documents - please click here to download Acrobat from Adobe.



Download PDF File
 
1 - Directions
Detailed directions to our clinic.
If you will be visiting us, please click on the pdf icon to the left and print this direction sheet.




Download PDF File
 
2 - Treatment to Minors
Consent form to treat minors
THIS IS A PDF FILLABLE FORM.
Please click on the pdf icon to the left, download it, fill it out using adobe acrobat on your computer and print. You can bring/mail/ fax to our office. Please do not email your medical information, email is not a secure form of communication.




Download PDF File
 
3 - New Patient Package
Forms package for new patients
THIS IS A PDF FILLABLE FORM.
Please click on the pdf icon to the left, download it, fill it out using adobe acrobat on your computer and print. You can bring/mail/ fax to our office. Please do not email your medical information, email is not a secure form of communication.




Download PDF File
 
4 - Consultation Request Form
Form for consultation request.
THIS IS A PDF FILLABLE FORM.
Please click on the pdf icon to the left, download it, fill it out using adobe acrobat on your computer and print. You can bring/mail/ fax to our office. Please do not email your medical information, email is not a secure form of communication.





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Dr. J. Michael Holsinger | Board Certified Dermatologist
161 Clint Drive Suite 100, Pickerington OH 43147 | (614) 866-8603
Serving the communities of Pickerington , Reynoldsburg , Pataskala , Newark
Canal Winchester , Lancaster , Gahanna , Grove City and the Greater Columbus Area

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Total Technology Solutions, Inc.
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