Forms

Patient Checklist of things to bring with you (you may fax them to 631-518-2002) or text your PDF to 631-666-2900

Bring with you:

• Driver’s license or other government photo ID
• Insurance card(s)
• Credit card. We are now (as of 7/2023) using a streamlined computer and billing system including ModMed Pay.  Your credit card information will be securely stored when you check in (we can never see the full number), and used to pay any copay to be collected at that time.  Upon completion of insurance processing, you will receive a text message summarizing their calculations, and how much you may owe.  A week later, your card will automatically be charged for that amount.  (If, for any reason, you believe an error has been made, contact your insurance company or our billing office for clarification.)

Form you can download, print, and complete before your visit:

• Patient Information Form
• Office and Financial Policies

There is no need to bring in any of the following; they are posted here for your information.

Mohs Surgery Information:

• Patient Checklist
• Mohs Micrographic Surgery Information
• Mohs Surgery Wound Care Instructions

Plastic Surgery Information:

• Consent Form for Plastic Surgery Procedures
• Plastic Surgery Wound Care Instructions

Wound Care:

• Instructions for your wound care

Office and Financial Policies

If we’ve given you login information for direct access to our Patient Portal, click here.