Forms

In order to expedite the registration process, please print and fill out the patient information forms and bring them with you to your first visit along with your insurance cards and a valid ID card.

We accept most major health insurance, including Medicare. As a courtesy, we will file a claim with your health insurance company and will attempt to collect payment for all medically necessary procedures and office visits.

Copays and deductibles will be collected at the time of your visit. Please contact your insurance company with any questions regarding your specialist copay or deductibles as individual insurance policies may vary.

If you have an HMO or managed care policy, it is your responsibility to ensure a referral is obtained from your primary care physician. A referral is NOT required for PPO policies.

Click on links below to download patient information forms.

 

HIPAA Patient Consent
HIPAA Notice of Privacy Practices
Patient Information
Referral Information, Patient Financial Policy & Signature on File
Minor Patient Registration
Dermatology Medical History
Financial Policy & Disclosure
Authorization for Transfer of Medical Records