Patient Records

Welcome new patients!

Please download your forms below. We do require a driver’s license or other proof of ID when you come in for your first appointment. Please call our office with questions. Look forward to seeing you soon!

Print Patient Intake Form

We have exciting news regarding your healthcare!

We are proud to announce that our practice now offers you the opportunity to use the power of the web to track your healthcare through our office. The Patient Portal enables our patients to communicate with our practice easily, safely, and securely through the internet.

Launch Patient Portal


Will my visit be covered by my insurance?

Medical insurance coverage has changed over the last few years. We would like to try to explain how medical insurance works and what you can expect from an office visit. When you see a physician, your medical insurance is billed for the office visit and for any procedures you have during the visit. Your insurance then pays the doctor a negotiated rate for the services. If you have a deductible or co-insurance, then you are responsible for the charges. For most plans, once the deductible is met for the year then the charges are covered by the insurance company.

In dermatology these are some of the common procedures performed. Below are CPT codes that you can use to determine costs by calling your insurance company and asking them their negotiated rate.

If you have a procedure during the office visit, these charges would be additional.

Treatment of warts with liquid nitrogen CPT 17110 (charged at each office visit)

Treatment of molluscum with cantharone topical liquid CPT 17110 (charged at each office visit)

Treatment of pre-cancers with liquid nitrogen CPT 17000 and 17110

Treatment of seborrheic keratosis with liquid nitrogen (barnacles. Must be medically necessary) CPT 17110

Incision and Drainage of Cyst CPT 10060

Steroid injection (ex: acne, psoriasis, rashes, alopecia areata) CPT 11900

Skin Tag Removal (must be medically necessary) CPT 11200

Acne surgery CPT 10040

Shave biopsy CPT 11100 plus additional path fee (billed from path lab)

Mole removal via punch tool on trunk, arms or legs CPT 11401 plus path fee (billed from path lab)

Mole removal via punch tool on other locations-CPT provided on request

Excisions of benign & cancerous growths vary greatly depending on size of tumor and location on body. Please ask us for codes based on your specific condition.

Sometimes it is difficult to predict which of the above services you will need during your office visit. If you would like to contact your insurance company first to determine what you might owe, we will be happy to provide you the codes at the time of your office visit and schedule a follow-up visit for the procedures.

We always try to send blood work and biopsy specimens to in-network providers but ultimately it is your responsibility to notify us of which lab is in-network. Bills from the lab for their services are sent directly from them as we are separate entities. If you have questions about their billing statement, then you need to contact the lab directly. Since we are a separate business we do not have the ability to work with your lab account.

If you have no insurance, then you are responsible to pay your charges. We are happy to share our self-pay rates on request.

What are cosmetic charges and can they be billed to my insurance Company?

Cosmetic charges are for services that are deemed not medically necessary. Examples of these services are removal of benign growths (moles, skin tags etc), Botox or Dysport treatments, injections for underarm sweating, filler treatments with Juvederm or Restylane, PRP treatments for hair regrowth, products sold in the office, etc. These services are never billed to the insurance company and payment is expected at the time of service. If a service is cosmetic we provide patients with a written consent form clearly stating the services to be performed and the cost before any cosmetic services are provided.

If you are scheduled for a cosmetic appointment and have medical questions such as a lesion on your body, rashes, hair loss, acne etc., if time permits, we can address those medical questions. Those medical charges will be billed to your insurance. If you are self-pay then you are responsible for the medical charges as well.