Patient Information and Forms
In order to prepare for your first office visit, please print and complete the patient information forms on this web site. Bring them with you for your first visit. Also bring your current insurance card and photo ID such as driver’s license or passport, or other type of photo ID.
Click here for NEW PATIENT FORMS
Click here for COSMETIC INTEREST QUESTIONS
Click here for NOTICE OF PRIVACY
Click here for FINANCIAL POLICY
By signing the financial information form, you acknowledge full responsibility for the payment of services rendered. Insurance coverage is a contract between you and your insurance carrier. As a service to you, we will file your insurance claim if you assign the benefits to the doctor. Prior to service, we will collect your office visit co-pay as per your insurance company’s directions. If a procedure is performed, we will collect the applicable deductible and/or co-insurance. Your insurance company may expect you to pay higher amounts for visiting a specialist such as a dermatologist.
If the dermatologist performs any of the following: skin biopsy, injections, curettage (scraping), electrodessication (burning), freezing or excising a lesion or growth, your insurance company may consider this office surgery subject to a deductible. Please notify us immediately if your insurance carrier changes or is terminated so that we may process your claim in a timely and accurate manner. If you fail to give us correct information, we may have to bill you for services rendered. If your insurance company does not pay your insurance claim within 90 days, we may ask that you assist us by calling your insurance company for claim status. We may also have to start billing you for payment of your medical service.
Please call us (281-491-9278) at least 24 hours in advance to reschedule if you are unable to keep your appointment. This would allow someone else to take your place. If you arrive late for your scheduled appointment, we will try to accomodate you. You may have to wait while we work you in, or you may reschedule. If you simply do not show up for your appointment we may assess a $25.00 charge. Our goal is to make unused appointments available for other patients and not to collect missed appointment fees.
COSMETIC APPOINTMENT POLICY
To hold your cosmetic procedure appointment, a $100.00 deposit is required. As we schedule a large block of time for your cosmetic procedure, we regretfully will have keep your deposit if you do not show up. Should you have any questions or concerns please do not hesitate to call us at 281-491-9278.