Dear Valued Patient
Every year we are required to have our patients fill out new Patient Information forms. This helps our office keep your records current as well as submit claims to the correct insurance. Please view, download, and fill-out these forms completely at your earliest convenience prior to your scheduled appointment. Although your information may not have changed at all, we still need a new completed form on file each calendar year.
Please view and download the forms that are required at your first visit of the new calendar year:
- Medical History Form
- Patient Information Form
- Cancellation No Show & Late Policy
- Consent and Pharmacy Form
- Notice of Health Information Privacy Practices
- Financial Policy Form
We do require our patients to arrive 15 minutes prior to their scheduled appointment time. This allows us time to prepare your chart and collect any applicable co-pays and any past-due balances. If it becomes necessary for you to cancel your appointment, please notify us 24 hours in advance. Minors (under 18 years of age) are required to bring a parent or legal guardian to the first appointment.
Keep in mind that new insurance cards are distributed at the beginning of the calendar year. Giving us the most current information and insurance card will help us file your claim correctly and avoid having to ask for additional information later.
The staff at Summit Dermatology always appreciates the understanding of our patients.
The Staff at Summit Dermatology