PATIENT INFORMATION AND FORMS
Welcome to Dermatology Associates! Thank you for choosing us as your skin's health-care providers!!
New Patient Forms
If you are new to Dermatology Associates please assist us in making your first visit as uncomplicated and enjoyable as possible!! For your convenience, we have supplied all required new patient forms below in PDF format. Prior to your appointment, please take time to download and complete all necessary paperwork provided below. (Please note: patients who have visited before, but have not been seen for 3 or more years are considered to be new patients and therefore must once again complete the listed new patient forms.
Returning Patient Forms
For those patients who have visited us within the past 3 years, returning patient forms have been provided for your convenience. Please complete and bring the relevant forms with you to your appointment.
Patients under the age of 18 must be accompanied by a parent or documented legal guardian for their first appointment. After the initial visit, you may sign an Authorization to Treat a Minor form that will allow us to see your child in your absence for follow-up care appointments. This Authorization to Treat a Minor form is located on the Dermatology Associates, Inc. Registration form.
If you cannot keep your appointment, we ask that you cancel office visits 24 hours in advance and surgical visits 48 hours in advance. There will be a $50.00 charge for any missed office visit or cosmetic appointment and a $75.00 - $200.00 charge for any surgery appointment not cancelled. These charges are patient responsibility and cannot be billed to your insurance company.
For information regarding the insurance providers we currently accept, please download the New Patient Welcome Form located above.
Bring to your Appointment:
Your Insurance Card(s). Please note: if you do not bring your insurance card(s), you will be considered Self-Pay.
Listing of any medications to include vitamin and herbal supplements you may be taking.
How to Mail Forms
If you have decided to mail these forms ahead of your scheduled appointment date, please ensure that you mail these forms directly to our Winchester location on Amherst Street in order to ensure timely processing:
1514 Amherst Street, Winchester VA 22601