Daphne Panagotacos, M.D., Inc.

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    • Mohs Surgery
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  • Contact
(805) 379-3376

Patient Forms

Patient registration forms and the arbitration agreement.

Patient Information

  • Patient Registration Forms – All
  • Privacy Standards Notice
  • Medical record Release
  • Mohs information packet
  • Post op instructions for biopsy and scraping (C&D)
  • Post op instruction for excisional procedure with sutures (closed wound)
  • Pre and Post op instruction for Botox
  • Pre and post op instruction for fillers
  • Release for minor to be treated without parent present
  • Sclerotherapy information sheet
  • Post of for laser hair
  • Post op for non-ablative
  • Information on Levulan Photodynamic Therapy (PDT)
  • Pre and post op instructions for PDT
  • Pre and post op for liquid nitrogen

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Visit Us

Our goal is for you to leave our office with a memorable and enjoyable experience, which is why our welcoming and compassionate staff will do everything they can to make you feel right at home.

  • 32144 Agoura Rd, Unit 106
    Westlake Village, CA 91361
  • (805) 379-3376

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Appointments

We will do our best to accommodate your busy schedule. Request an appointment today!

Request Appointment

Contact Us

32144 Agoura Rd, Unit 106
Westlake Village, CA 91361

Phone: (805) 379-3376

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