Returning Patient Forms

For returning patients: the forms listed below have been updated.  If you have not yet signed the updated versions of these forms the last time you were in the office, then please print, review, and fill-out these forms.  Please bring these forms to the office for your next visit:

Notice of Privacy Act (please read this updated version, but you do not need to print it)

Acknowledgement of Privacy Act Form

Skincare Questionnaire (new as of Oct 18, 2017)

Designated Individuals Authorization Form

New Age Dermatology Financial Policy

**Reminder: please also bring your insurance card + picture ID to your appointment.  Insurances accepted:

Aetna, *Blue Cross Blue Shield, State Health Plan of North Carolina (BC/BS), Cigna, United Healthcare, Wellpath, Coventry.

*Please note, we do NOT accept BCBS Blue Value Plan (prefixes are YPV, YPJ, YPL).  We also do not accept Medcost – Humana – Blue Local – Tricare – Medicaid and now any  new Medicare patients.

If your insurance company is not listed above, please feel free to contact our office for the most recent plan participation information.

For complete skin exams: No self tanner applied several days before your appointment so moles can be clearly seen.  And please no nail polish so your nails can also be checked for skin cancer.

Waiting List:

If you would like to be seen sooner than your appointment please ask our scheduling staff to put you on the waiting list and you will be called as soon as any cancellation appears.