Theta S. Pattison, M.D. I Kavita Menon, MD. t Alexis Perlmutter, M.D. [ Erin Winter, M.D. ... If Signed by someone other than the patient, please specify your authority to act for patient: Theta Dermatology 2508 Western Avenue Altamont, NY 12009 Phone: 518-690-0177.