New patient forms

Please complete the online forms below or print & return the completed forms at the time of your appointment. In order to be scheduled for an appointment all questions must be answered. We must have a copy of a government-issued identification card to verify each patients identity and a copy of your insurance card(s) to file your insurance.

Payment and Insurance

We accept most insurances and will file it as a courtesy to you.  It is also our payment policy to collect any co-payment, deductible and/or co-insurances at the time of your visit. If you are receiving cosmetic services or aesthetic procedures, such as Botox, Fillers, SkinPen, Silk Peel, or Facials, payment for these services will be required in full at the time of your visit as most of these are not covered by insurance. We accept cash, checks, major credit cards, money orders, as well as Care Credit.

No show and cancellation policy

If you have unforeseen scheduling conflicts, we will be happy to work with you in rescheduling your appointment to a time that is more convenient for you.  Please be advised that we require no less than a 24 hours' notice to cancel or reschedule an appointment. You will be billed $25 for any missed appointments or appointments not cancelled within this time frame. This fee must be paid prior to the appointment being rescheduled. A call to reschedule an appointment in advance will allow us to use the appointment time for other patients needing to be seen.

New Patient Registration Information

Please take the time to completely fill out the patient's information below.

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Ethnicity or Race (choose all that apply)
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Is the patient already scheduled for an appointment?