Patient Forms (Downloadable)
We strongly encourage our patients to complete Patient Information & History directly through our Patient Portal. However, if you are not able to access the portal or, if you simply prefer, you also may download the appropriate form(s) below, fill them out, and bring them with you on the day of your appointment. We look forward to seeing you in our Denver or Longmont office.
Option 1 (for patients who have NOT completed our Patient Portal)
Option 2 (for patients who HAVE completed our Patient Portal)
For All New Patients
- Office Policies (Download)
- HIPAA Privacy Policies (Download)
- Office Collections Acknowledgment & Authorization (Download)
ESTABLISHED PATIENTS (must complete annually at 1st visit of the calendar year):
For your convenience, we have also provided other frequently requested forms, authorizations, and helpful information.
To facilitate referral coordination, please ask your referring provider to complete our fax cover sheet and fax the requested information to our office at (303) 761-0907.
On the day you visit our Denver area dermatology and Mohs surgery practice for your appointment please bring your insurance card. Be sure that any required referral has been processed. Insurance co-pays are expected to be paid at the time of your visit.
We accept most major insurance carriers (including, but not limited to, Aetna, Anthem Blue Cross/Blue Shield, Banner Health, Beech Street, Cigna, Clear Spring, Cofinity, Coventry First Health, Friday Health Plans (f/k/a Colorado Choice Health Plans), Humana, Kaiser (Denver/Boulder Members Only, Referral Required), Medicare, Multiplan, Oscar, PHCS, Rocky Mountain Health Plans, Tricare, TriWest, United Healthcare & VA). Please call your insurance provider prior to your first appointment to confirm that we participate in your insurance plan.
Please be aware of your individual deductibles, co-pay and co-insurance amounts. Insurance coverage does not guarantee insurance payment.
You will receive a statement that lists any unmet deductibles, co-pay and co-insurance amounts due after your insurance has paid the portion covered by your plan. Prompt payment is appreciated.
Often procedures require a prior authorization (PA) from your insurance company. Our office will assist in obtaining this authorization from your insurance company prior to your procedural visit. This requires substantial work and may be a lengthy process, so please do not hesitate to contact our office to check your prior authorization status.
Cosmetic treatments are out of pocket non-insured billable expenses. A cosmetic consultation will enable you to determine the best treatment plan for you.