What to Bring to Your Appointment
For your convenience, all registration forms, medical history forms, and skin eruption forms are available for download below. Adults who use their parents' insurance should fill out a Minor Registration Form. Please bring your completed forms to the office for your first visit, and update your information yearly.
Insurance and Payment Information
We are providers for most PPOs and HMOs, including BCBS, Prudential, St. Vincent CMO, Aetna US Healthcare, Cigna, Sagamore and many more. We accept Medicare assignment. If you are unsure if we are in network, please call member services on the back of your insurance card and inquire with your insurance company.
As a courtesy to our patients, we will submit charges to your insurance company. Co-payment is expected at the time of visit.
- Your insurance card
- Physician referral forms, if required by insurance
- List of prescriptions and/or over-the-counter medication, including dose and frequency
- Information about your medical and surgical history
- Recent x-rays or relevant records
- Up-to-date Registration and Medical History forms
For your convenience, all registration forms, medical history forms, and skin eruption forms are available for download below. Adults who use their parents' insurance should fill out a Minor Registration Form. Please bring your completed forms to the office for your first visit, and update your information yearly.
Insurance and Payment Information
We are providers for most PPOs and HMOs, including BCBS, Prudential, St. Vincent CMO, Aetna US Healthcare, Cigna, Sagamore and many more. We accept Medicare assignment. If you are unsure if we are in network, please call member services on the back of your insurance card and inquire with your insurance company.
As a courtesy to our patients, we will submit charges to your insurance company. Co-payment is expected at the time of visit.
| adult_registration_form.docx |
| adult_registration_form.pdf |
| minor_registration_form.docx |
| minor_registration_form.pdf |
| new_patient_skin_test_instructions.docx |
| new_patient_skin_test_instructions.pdf |
| new_patient_medical_history_form.docx |
| new_patient_medical_history_form.pdf |