To save time and make the process more convenient, you can fill out several forms at home before your appointment. Just click on the button below to print out a copy of the form on your printer, fill it out and bring it to your appointment.
Forms are available in Adobe Acrobat PDF format. Please click the link to download the appropriate form:
New Patient Paperwork
CONSENT AND PRIVACY FORM (ENGLISH/SPANISH)
HEALTH HISTORY (2 PAGES)
Don't forget to bring your photo ID, insurance card, and prescription card to your first visit!
PATIENT AUTHORIZATION TO DISCLOSE HEALTH INFORMATION
AUTHORIZATION TO PROVIDE TREATMENT TO MINORS (ENGLISH/SPANISH)
Clear Skin Dermatology accepts most private insurance plans as well as Medicare.
CANCELLATION/NO SHOW POLICY
We understand that there are times when an emergency will prevent you from keeping your appointment. In those instances we ask that you notify the office prior to your scheduled appointment time. Should you fail to provide us with this advance notice, the corresponding fee will be charged.
No-show or cancellation with less than 24 hours notice for office visits = $25 Fee
No-show or cancellation with less than 48 hours notice for surgeries and cosmetic procedures = $100 Fee
It is our goal to provide all of our patients with an appointment time that matches their needs, and your cooperation with this policy helps make this possible.
Thank you for your understanding!
To help you stay informed, listed below are some materials and videos that can help you identify and prevent skin cancer as well as links to the top dermatology websites.
VIDEOS AND FLYERS
Sunscreen Information Flyer (pdf)
Self Exam and Body Mole Mapping Instructions (pdf)
How to apply Sunscreen (video)
How to perform a self exam (video)
American Academy of Dermatology https://www.aad.org/
American Society for Dermatologic Surgery https://www.asds.net/Public-Resources/
Spot the Spot, https://www.spotthespot.org/
The Skin Cancer Foundation, https://www.skincancer.org/
American Cancer Society, https://www.cancer.org/