Prepare for your visit

When you have an appointment with Medical Center Dermatology, you can print out these forms in advance, complete them, and bring them with you to the office for your appointment.

Our doctors are contracted with many insurance plans. They also see Medicare and self-pay patients. All patients will need to bring their photo ID and insurance card to every visit.

New patients

Medicare patients

1. Patient History & Review of Systems (2 pages)
2. Medicare Emergency Contact Form
3. Notice to Medicare Patients
4. HIPAA Privacy Notice (5 pages)
5. Medicare Patient Registration

Other patients

1. New Patient Information
2. Patient History & Review of Systems (2 pages)
3. HIPAA Privacy Notice (5 pages)

All established patients

1. Patient Information (if any changes or if not seen for over a year)
2. Patient History & Review of Systems (2 pages) (if any changes or if not seen for over a year)
3. HIPAA Privacy Notice (5 pages)