referring providers

For surgical referrals to Complete Dermatology, please click below to download our referral form.  

 

 

 

Surgical Referral Form 
 

 

You may fax the completed form along with supporting documentation to Complete Dermatology, 808-627-6000, or send it to mohs@complete-dermatology.com. All transmissions will be received into a HIPAA-compliant system.

Alternatively, you can fill out the following online referral form. Please note, in this case you DO NOT need to fill out the surgical referral form.

Surgical Referral Form

Patient Information

Appt Type Requested
Upload Photo - Site A

Location A

Location Photo - Site B

Location B

Thanks for submitting!