• Your photo ID.

• Your health insurance card (please verify eligibility and benefits through your insurance carrier prior to appointment).

• Written referral from your primary care physician if your insurance carrier requires this for claim payment.

• Any copay, deductible, and/or coinsurance amounts are due at the time of service.

• An up-to-date list of your medications.

Our goal is to provide patients access to our highly trained staff in a timely, efficient manner. If, for any reason, you cannot keep a scheduled appointment or will be delayed, please call as soon as possible. If you are going to be delayed more than 15 minutes, it will be necessary to reschedule your appointment for another time.

Surgical Appointments - Cancellation/Rescheduling of a surgical appointment must be made at least 48 business hours prior to the scheduled appointment time. The appointment must be cancelled directly with a staff member, not through email, and not with the answering service. Failure to appropriately cancel a surgical appointment will result in a $175 cancellation fee.

Cosmetic Appointments - Cancellation/Rescheduling of a cosmetic treatment session must be made at least 48 business hours prior to the scheduled appointment time. The appointment must be cancelled directly with a staff member, not through email, and not with the answering service. Failure to appropriately cancel a cosmetic appointment will result in $100 cancellation fee.

For your convenience, we have listed the most common insurance plans and our provider status.

AETNA

BLUE CROSS BLUE SHIELD

UNITED HEALTHCARE

HUMANA

MEDICARE

TRICARE SELECT

This list is not a guarantee of coverage or participation. Due to insurance companies’ frequent changes; it is the patient’s responsibility to contact the insurance company directly to verify that they are eligible for medical services and that we are an in-network provider.

The following copay, coinsurance and deductible requirements apply to ALL insurance plans:

Insurance Copays and Coinsurances - Most insurance plans require patients to make a co-payment at the time of their visit. We ask that patients come prepared to pay any copay amount at the time of service.

Insurance Deductibles - Many insurance plans have separate deductibles that apply to surgical procedures, labs, and pathology tests. Wart removal, injections, and destruction of skin lesions are considered surgical procedures by insurance carriers and deductibles can apply. We ask that the patient contact the insurance carrier if they have any questions as to whether a deductible will apply. We ask that patients come prepared to pay any deductible amount at the time of service.

NO INSURANCE: If a patient does not have any insurance coverage, they will be responsible for payment in full at the time of service. If a payment plan is desired, we ask that the patient speak with our billing office prior to the visit.

We cannot guarantee coverage for any insurance company. The PATIENT is responsible for verifying we are in network with their plan. The PATIENT is responsible for obtaining referrals through their PCP. The PATIENT is responsible for copay, deductibles, non-covered services and cosmetic services at time of service.

We accept checks, cash and all major credit cards.

Depending on your medical condition, the physician may deem it necessary to send pathology to a laboratory for further testing and diagnosis. If this is done, we do send your insurance information along with the specimen. The lab is off site. They will file a claim for lab services directly to your insurance company. You will receive a statement from the lab for any coinsurance or deductible amounts.

New Patient Paperwork

Notice of Privacy Practice

Medical Records Request

Parental Authorization to treat a Minor

Liquid Nitrogen (LN2) Wound Care

Surgical Wound Care

Biopsy Wound Care

Efudex/Carac Wound Care

PDT (Blue Light) Care

Mohs Pre-Op Information

Mohs Wound Care Form

1540 Resurfacing Care

IPL (Intense Pulse Light) Care

Microdermabrasion Care

SkinPen Care

Vectus Care

Vascular Care

Dermal Fillers/Toxins Care

Sculptra Care