Patient Forms


 

New Patients


New patients will need to pre-register a week before their appointment in order to secure their appointment. Failure to do this will result in cancellation of the appointment. Pre-registration will require a picture ID, insurance card, and a referral if your insurance requires it.

In an effort to serve you better, we ask that you please arrive 10 minutes before your scheduled appointment time.

DOWNLOAD NEW PATIENT FORM HERE

DOWNLOAD MEDICARE INSURANCE FORMS HERE

DOWNLOAD COMMERCIAL INSURANCE FORMS HERE


Lab-Work or Biopsies


Regardless of your insurance, if you require lab-work during your visit, you will receive a bill from the laboratory where you get your lab-work drawn. If you require a biopsy during your visit, there will be a separate bill both for the lab that processes the biopsy and the physician who reads the biopsy.


Payment


We accept Master Card, Visa, Discover, cash, and checks. Payment is due at the time of service. All cosmetic consultation and procedure fees must be paid in full before the consult or procedure is performed. We do not bill or accept payment from insurance companies for cosmetic procedures.


Cancellations


As a courtesy to all of our patients, we ask that all cancellations be made at least 24 hours in advance of the scheduled appointment time. Failure to comply with this request will lead to a $50 “No Show” fee for the day of that appointment. This will be billed directly to the patient and not to the insurance company. We ask that follow-up patients arrive for their appointments on time. If you are late, we will make every effort to see you the same day. However, you may be asked to reschedule if the doctor’s schedule is full.

 

Location
Integrated Dermatology of Yuma
2500 South 8th Ave., Suite 101
Yuma, AZ 85364
Phone: 928-788-0785
Fax: 928-783-0634
Office Hours

Get in touch

928-788-0785