Registration | Dermatology & Aesthetics of Wicker Park

		Dermatology & Aesthetics of Wicker Park 1455 N. Milwaukee Avenue, 2nd Floor Chicago, Illinois 60642 P: 773.276.1100 F: 773.276.1102


Home Our Providers Keren B. Horn, MD Meyer A. Horn, MD Neha D. Robinson, MD Peter A. Lio, MD Meredith Feinberg, Licensed Aesthetician Our Office Frequently Asked Q & A Insurance Information Document Library Cosmetic Dermatology Medical Dermatology Registration Contact Us

Adult & Pediatric Dermatology

Skin Cancer Screenings
XTRAC Laser for Psoriasis & Vitiligo
Acne
Rosacea
Psoriasis
Warts

Cosmetic Procedures

Botox®
Restylane®
Juvederm®
Laser Hair Removal
Laser treatment of broken blood vessels
Chemical peels
Microdermabrasion (Silk Peel®)
Facial Treatments
Photorejuvenation

Please fill out ALL of the following forms and bring to your appointment!

Demographics

Health History

Financial Policy

HIPAA

**If you are under the age of 18, please have your parent or guardian complete the following form and bring with you to your appointment.

Treatment of Minors Consent