Policies and Forms

New Patients

A new patient MUST arrive 15 minutes prior to your scheduled appointment time to complete the registration process. For your convenience and ease, you may download, print, and complete the Patient Registration Form to bring with you. Please make sure to bring your insurance card, government issued ID, and preferred credit card to your visit. As required by your insurance provider, please ensure your referral is in place prior to your visit.

Cancellation Policies

Dermatology Associates requires at least 24 hours notice if you must cancel an appointment. If a visit not kept or is cancelled inside 24 hours, the patient will be charged $50.00. Dermatology Associates keeps a cancellation list and all attempts will be made to contact those who have requested to be on it when a visit is cancelled.

Aesthetics & Cosmetics Cancellation Policy

In attempt to fulfill everyone’s scheduling needs, we require all patients give at least 24 hours notice to change an Aesthetics & Cosmetics appointment. If a patient does not show up or cancels a clinician visit without required notice, s/he is subject to a $50 cancellation fee for that visit.  If a patient violates the cancellation policy twice, a $100 deposit will be required to schedule future clinician appointments until notified otherwise. The deposit will be credited to charges incurred at the scheduled visit or may be forfeited if the cancellation policy is violated. This policy is effective November 10, 2014 and is subject to change at the discretion of management. We thank you for your understanding and cooperation!

Treatment of Minors

Dermatology Associates requires a parent or legal guardian accompany a patient under the age of 18 to his/her initial visit. Parents can choose not to accompany the minor on follow-up visits by completing our Parental Pre-Authorization for Medical Care to Minors Form and submitting it to be kept in the minor’s file. As required by the patient’s insurance provider, a valid referral and copay are expected at the time of visit. Minors cannot sign a referral waiver and may be refused service if the referral is not in place.

Medical Records Request or Release

If you would like your health records shared with or by Dermatology Associates, you may print our Patient Authorization for Use and Disclosure of Protected Health Information Form and fax, mail, or hand-deliver a completed copy to any of our offices for submission. Please note, it must be signed by both the patient/parent/guardian. Release forms are valid for 90 days from the signature date. There may be a charge associated with the processing of records.

Notice of Privacy Practices

Medical providers are required by law to protect patients’ privacy of health information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review our Notice of Privacy Practices.

Financial Policy

Please review our Financial Policy and check our Billing & Payments page for more information, including our Credit Card on File system.