Portal and Forms

The BREEZE Patient Portal serves two purposes.

• replaces paper forms and is how we collect your information for your appointment.
• Make Payments.  You can make a secure on-line payment with BREEZE either from the link here on NJDermDoc.com or by downloading the BREEZE APP from Google Play or Apple APP Store. 

You may access the BREEZE Portal here  or click on the BREEZE logo below.

The EMA Patient Portal is a different portal where your medical history with us is maintained. You can see your information on your visits.

EMA FOR NEW USERS: 

New users to EMA  – CLICK HERE for instructions and sign in. 

EXISTING EMA USERS:

Existing EMA users click the link below or CLICK HERE to access EMA.

Download these forms and bring to your appointment.

Also see our Patient Quick Guide or the Question and Answer (Q & A)  Guide.

Click on each link to open the form and download.

• Patient Intake Form
• Certified Consent to Treat Minors
• No Show Policy
• Informed Patient Consent Form
• Credit Card on File Form
• Statement of Financial Policy
• HIPPA Privacy Form
• Acknowledgement of Privacy Form
• Medicare ABN Form
• Medical Record Request Form