Before your first visit

If you are a first-time patient, you can speed your visit by downloading, printing, and filling out the following paperwork ahead of time.

All new patients should complete and bring both of theses forms for their first visit:

New Patient Medical History Form (pdf)
Cosmetic Services Signature Form (pdf)

Please fill out and bring ONE of these forms, depending upon your insurance:

New Patient Registration Form (pdf)
New Patient Medicare Form (pdf)

This is for your information only. You do not need to bring this form with you:

Privacy Policy (pdf)

We accept the following forms of insurance

	Traditional	SuperMed Classic®	SuperMed Professional™	SuperMed Plus®	SuperMed Select®	SuperMed HMO®	SuperMed Preferred	Advantage Plan
	Blue PrioritySM	Blue Preferred® Primary (HMO)	Blue Preferred® Primary Plus (POS)	Blue Access®(PPO)	Blue Traditional®	Lumenos Health Savings Account	Anthem Senior Advantage
Medicare & Railroad Medicare
** For other insurances not listed above, we do not directly bill your insurance company for our services. Instead, we will provide a signed, coded, standard insurance form which can be turned in to your insurance carrier for reimbursement. You will be responsible at the time of service for payment of services rendered.