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 using a streamlined computer and billing system.  Your credit card information will be securely stored.  Whatever amount your insurance company says you owe us (copay, coinsurance, deductible) will be automatically charged to your card.  (If, for any reason, you believe an error has been made, contact your insurance company or our billing office for clarification or refund.)

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

• Patient Information Form
• Office and Financial Policies

[ Please note: your personal and healthcare information is stored by our business partners in an industry standard encrypted and secure way, compliant with the HIPAA requirements. It is kept for our business use, or for use by our business partners, like your insurance company, only.  We never share your information with any outside parties for marketing or any other purposes that are not directly involved with our providing you healthcare or for billing of same.  ]

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.