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patient forms

Sign these if you are a new patient, before you come in.

You may download our patient forms and fill them out in advance to save time when you come in for your consultation. This file contains:

Consent to Treatment
Communications Release
HIPAA Authorization and Signature Pages
Patient Financial Responsibility Form

New Patient Form

Pinnacle HIPAA Release

Patient Financial Responsibility & Now Show Policy Form

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See what our clients are saying

I first went to a dermatologist in my area who was horrible who basically said I was old so I stopped going there. I ended up with a spot on her face that I knew was not correct so I went a year or so later to another Dermatology practice and had a biopsy done. I was a number there, and they didn’t spend the time with me that I needed. I had Mohs surgery done with that practice and the surgeon was excellent and it’s healed very nicely but that surgeon was extremely busy and was in and out. That surgeon is no longer there and I was sent a letter introducing the new doctor and I didn’t feel a connection to them. My mom went to Pinnacle Dermatology and she was very happy with them. The only thing that I questioned was her mom had Mohs surgery in same day as her appointment. That’s not what happened at my previous dermatologist but I figured it was a good time to get checked at that office. I went to the new office located in Ottawa and I am telling you, Stacy and her aide are fabulous. She took her time, I did not feel rushed at all, she checked everything over, and said the spot on my temple that I was concerned with was a bug bite that got irritated. I was elated walking out of the office. When you have problems with your skin, everyone says it’s nothing to worry about but when it happens to you it is something to worry about. I feel safe and secure at Pinnacle, like I’m in good hands. - Patsy

3 years ago, I saw what I thought was a mole on my breast area and determined I should get it checked. I made an appointment with Pinnacle Dermatology because other friends had gone there. May 6^th was my appointment and the doctor noticed a dent in the same breast. I don’t do mammograms and I don’t get checked by doctors so I hadn’t noticed the dent or thought anything of it. She told me I needed to see my regular doctor. I told her I didn’t have one. She recommended a surgeon and would want a mammogram so she gave me the phone number and the doctor and told me to schedule an appointment before I left the parking lot. She didn’t know me but I’m the kind of person who would maybe eventually make the appointment, maybe not. Because she gave me such explicit instructions, I went out to the parking lot and did what I was told. By May 31^st I had had a lumpectomy and got two lymph nodes removed because it was cancer. I’m happy to report the doctor said I’m at very low risk of recurrence and I owe it all to the Pinnacle Practice and the doctors there for pushing me to do what I needed to do. - Patricia

I have been to 5 dermatologists, and I quit going to the others because I didn’t care for their attitudes. I picked Pinnacle Dermatology out of the yellow pages. My doctor at Pinnacle is open and friendly and they are all willing to sit down and talk and hear me out. They don’t make you feel like you are stupid for getting sunburned. I had one basal cell removed and melanoma removed and the next one is squamous cell. I live in Valparaiso, IN and am so happy they opened a practice here. - James

The providers at Pinnacle Dermatology always take the time to answer any of my questions. I’m on the 6-month plan to have my skin checked. I had something removed from my back and when I had the procedure done, there was no waiting, I had an immediate response. I originally found the practice though a recommendation and have been with them longer than 10 years. I am very satisfied with the office, I always get calls back and everything is always taken care of. I trust my doctor, this is the key importance. ~Martha

I can only tell you good things about Pinnacle Dermatology. I had a cyst removed and have been many times since the office opened in Frankfort. I found out about the practice because I met the doctors through a lecture about dermatology at a healthcare open house. I was very impressed with them and what they had to say. At that time my mom and I were going to another dermatologist in the area and my mom had squamous cell all over her body. I have the same skin as her and she baked in the sun as a younger person. The dermatologist at the time, wanted to do a biopsy on my cheek and I didn’t want a chunk out of my skin. I went to Pinnacle as a second consult and found out at the time the biopsy wasn’t necessary so I saved my skin and haven’t had a problem since. I see the doctor frequently and they take care of me. They are always up front and honest and it’s very refreshing to get all the facts up front. Everything they’ve done for me has been accurate and it’s never been pushed on me. They’re very well informed and I feel like they have a calling for what they do. ~ Patient that wishes to remain anonymous

I have known Dr. Lapinski since she was a young girl and I know how very, very smart she is. Her and the Pinnacle Dermatology practice have taken care of my family’s dermatology needs for many years. She is quite the doctor, very in tune to her patients which is so important and you don’t often see that. Her patient to doctor skills are extraordinary. She’s very open to her patients and their needs. She knows her practice is growing and she is bringing on a lot of doctors that share the same qualities as her. She is tremendously honest and tells it the way it is and that’s what a patient wants to hear. She’s very good at explaining in a very kind, forthright way. People are not offended – that is a hard road to walk. I’m one of 5 girls in my family and none of them had ever seen a dermatologist before. I had to care for my mother and brought her to a dermatologist in the western suburbs that was well respected. That dermatologist no longer sees patients and all of us were left with no one. One sister lives in California and another in NH. My NH sister, Mary, is a nurse and she could not get a dermatologist to listen to her, even about the screening process. She would come here to visit and comment on how great my skin looked. My sister flies in once a year to see the doctors at Pinnacle Dermatology, how crazy is that? ~ Philomena

I have known Dr. Lapinski since she was a young girl and I know how very, very smart she is. Her and the Pinnacle Dermatology practice have taken care of my family’s dermatology needs for many years. She is quite the doctor, very in tune to her patients which is so important and you don’t often see that. Her patient to doctor skills are extraordinary. She’s very open to her patients and their needs. She knows her practice is growing and she is bringing on a lot of doctors that share the same qualities as her. She is tremendously honest and tells it the way it is and that’s what a patient wants to hear. She’s very good at explaining in a very kind, forthright way. People are not offended – that is a hard road to walk. I’m one of 5 girls in my family and none of them had ever seen a dermatologist before. I had to care for my mother and brought her to a dermatologist in the western suburbs that was well respected. That dermatologist no longer sees patients and all of us were left with no one. One sister lives in California and another in NH. My NH sister, Mary, is a nurse and she could not get a dermatologist to listen to her, even about the screening process. She would come here to visit and comment on how great my skin looked. My sister flies in once a year to see the doctors at Pinnacle Dermatology, how crazy is that? - Philomena

We have been with them a long time. We were diagnosed with melanoma by a local doctor, then referred to Pinnacle Dermatology. We in turn referred my father who had a massive carcinoma on his knee that was the size of an orange. We met Dr. Rios who performed the surgery for my father. After that success, we started seeing the practice for all dermatology needs. My husband and I do all body scans each year with them, we’ve had a lot of Mohs procedures done and we just think the team at Pinnacle is fabulous. We refer so many people to them. ~ Colleen

I had a tummy tuck with Dr. Rios 4 years ago. I popped by the other day to see him and he was thrilled to see me and the progress I had made. I had a great recovery period. Pinnacle had just opened an office locally not too long after I began looking for options. I checked Dr. Rios’ credentials and I didn’t feel I was going to get anything better anywhere else. After the first consult, I was totally at ease because he had a great demeaner. Since I had the tummy tuck I’ve lost another 25 lbs! Since becoming part of the Pinnacle practice, my kids have gone in to see the group for dermatology needs and it’s so convenient since the Bourbonnais office is literally two miles away. I cannot say enough great things about the people there and the practice. ~ Kim

I’ve been seeing Dr. Lapinksi since she only had one child so it’s been a long time since she now has 4! At the time I had a Primary Care Physician that has since moved out of the area, but she’s the one who referred me to Pinnacle Dermatology to begin with. I’m a red head and an amateur golfer and have been out in the sun a lot in my life and I get my skin checked every 6 months. I’ve had a few things removed over the years and every experience has been amazing. I feel like the doctors are family. They make you feel immediately comfortable and calm and answer/address any concern you have. They are personable and seem like non-clinical doctor. My husband came into one appointment with me and my husband was talking sports the whole time and before I knew it the procedure was over. You feel like they are a small family, even though the practice is growing. Doctors are people you trust and it’s difficult to start over trusting someone else which is why I will always stay with her. I was concerned with all the growth that I would have to wait for an appointment but that hasn’t been the case. I refer my friends to the practice all the time. I am relocating soon to southwest Michigan and I will still come back here to my providers at Pinnacle Dermatology until they grow to that area. ~ Diana

I don’t remember how I got to the Pinnacle Dermatology practice initially. I’m sure someone recommended me. In Bourbonnais, where I live, at the time there wasn’t a lot of options. I knew I had a scabby thing on her forehead and needed it taken care of as I’ve had Basal cell before. I went in to the Frankfort office and Dr. Lapinksi and I just hit it off right away. She has great bedside manner, very welcoming and I had a lot of confidence in her right away as she obviously knows very well what she’s doing. She completed a full body check and asked about a small mark on my neck. It looked like a little bruise, wasn’t raised, scabby or anything. She biopsied it, and it turned out to be a melanoma although very superficial. Dr. Rios did the surgery, margins were not clear the first time and I had to have a second surgery. I can’t say enough good things about Dr. Rios either. The most important thing was that I was very comfortable with them and they cared about me as a person in addition to taking care of me. I got her cell phone number right away to show how personable she is. You just don’t see that anymore. ~ Mary

I’ve had all 3 kinds of melanoma and I feel very confident that when we go to Pinnacle Dermatology everything will be taken care of and we can go on with life. Dr. Lapinski found the disease my husband had. He only presented with blisters on his fingers and it turns out it was a liver thing that manifested itself to show on his hands. Has had to have many procedures because of too much iron in his body over the past year and has had to stop the beers and the Tylenol. We went to Pinnacle and they researched it until they knew what was wrong. Dr. Rios fixed basal cell on my face and it’s gorgeous. They are just super people that we recommend any chance we get. ~ Maureen & Tom

3 years ago, I saw what I thought was a mole on my breast area and determined I should get it checked. I made an appointment with Pinnacle Dermatology because other friends had gone there. May 6th was my appointment and the doctor noticed a dent in the same breast. I don’t do mammograms and I don’t get checked by doctors so I hadn’t noticed the dent or thought anything of it. She told me I needed to see my regular doctor. I told her I didn’t have one. She recommended a surgeon and would want a mammogram so she gave me the phone number and the doctor and told me to schedule an appointment before I left the parking lot. She didn’t know me but I’m the kind of person who would maybe eventually make the appointment, maybe not. Because she gave me such explicit instructions, I went out to the parking lot and did what I was told. By May 31st I had had a lumpectomy and got two lymph nodes removed because it was cancer. I’m happy to report the doctor said I’m at very low risk of recurrence and I owe it all to the Pinnacle Practice and the doctors there for pushing me to do what I needed to do. ~ Patricia

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