For your convenience and efficiency, we have provided forms that can be completed online through a secure network. Please click on the links below, complete the information and click the submit button. We look forward to welcoming you to our office.
In an effort to efficiently serve you and other patients, you must PRINT and COMPLETE your New Patient forms prior to your upcoming appointment in order to be seen. If paperwork is not completed, this may result in rescheduling of your appointment.
Health Care Participation
We understand the importance of healthy, beautiful skin to your physical and emotional well-being. Our goal is to help patients get the medical treatment they need and the cosmetic dermatology services they desire. We accept Medicare, and contract with most major PPOs. Prior to calling our office, we suggest contacting your insurance provider to confirm we participate in your healthcare provider:
- Aetna
- Blue Cross Blue Shield
- Cigna
- Humana
- United Health Care
Our financial clerk is happy to assist you in obtaining maximum reimbursement from your insurance company for services that are covered under their plan. We are a CareCredit provider. (It’s convenient – you only need to go through the approval process once, no matter how many times you utilize CareCredit.) We do not participate in Medicaid or HMOs.
Payment and Insurance
Please be prepared to render payment when care is provided, including a charge for the initial consultation visit. You will incur additional charges for surgical or cosmetic treatments performed during your appointments, and for skin care items you choose to purchase. We gladly accept:
- Cash
- Personal Check
- Visa
- MasterCard
- American Express
- CareCredit
We structure our office hours to facilitate in-office medical and cosmetic procedures. That requires the scheduling of extended visits, so we must bill for missed or cancelled appointments.
Please be advised Humana Access Medical cards are not permitted to purchase products even those sold by a physician’s office. Please be aware that products should never be charged on any HSA (Health Savings Account) cards as products, do not qualify as medical expenses per the HSA guidelines set forth by the US Government, even those sold by a physician.
Medication Refills
It is your responsibility to request needed prescription refills at the time of your appointment. If you require medication between appointments, contact your pharmacy to see if you have additional refills on your prescription. If no refills remain, ask the pharmacy to fax the request to the respective office you were seen at (La Casita – 210.692.3000 Sonterra 210.370.9995) and please put attention to the provider you were seen by. Many medications are not covered by insurance companies. Ask your insurance provider for a formulary (list of medications covered under your plan). If you are calling our office to request a refill, please allow 48 hours for prescription refills to be processed.
Image Consultation
Your personalized image consultation will include open discussion of your medical and aesthetic concerns, treating them with respect and compassion. We analyze the present condition of your skin and create a customized program to help you your image goals.
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.