Patient forms

Patient forms

We appreciate that you have given us this opportunity and we look forward to meeting you.  We consider it an honor and a privilege to be your dermatologist.  In order to make your first visit a productive one, you will want to bring all necessary information.  This would include items such as:

  • Your insurance card and identification
  • A list of all of your medications that you are taking (over the counter and prescribed)
  • A change of clothing that allows full skin examination such as a swim suit (if desired)
  • Make up (in case we have to remove it)

You will be responsible for payment of copays and unmet deductibles at the time of service.  Please bring necessary forms of payment such as a check or credit card.

Patient Forms

We have created a secure HIPPA compliant way to complete all of your paperwork by clicking here.

Or you can print and fill out these forms so we can expedite your first visit:

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

Insurances accepted

Most major insurances are accepted including:

  • BCBS
  • UHC
  • Cigna
  • Coventry
  • Humana
  • Humana Gold Plus
  • Aetna
  • People’s Health
  • Medicare
  • Railroad Medicare
  • Champ VA
  • Tricare
  • Web-TPA
  • UMR
  • PHCS

Our Locations

Find us on the map

Hours of Operation

Our Regular Schedule

Monday:

7:00 am-5:00 pm

Tuesday:

7:00 am-5:00 pm

Wednesday:

7:00 am-5:00 pm

Thursday:

7:00 am-5:00 pm

Friday:

7:00 am-12:00 pm

Saturday:

7:30 am-12:00 pm

Sunday:

Closed