Patient Forms & Financial Policies
Quickly and conveniently obtain forms from our office. To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com .
If you are a new patient, you may print out the following 4 forms at home, fill them out, and bring them to your visit in order to expedite the process in the reception area.
- Patient Registration Form
- Patient Clinical History Form
- Financial Policy Form
- HIPAA Consent Form
- RHIO Consent Form
- Botox Post-Treatment Instructions
- Wound/Surgery Post-op Instructions
- Filler Post-Treatment Instructions
- Liquid Nitrogen Blister Care
We currently participate with many major insurance companies. Please call our Rochester office at (585) 232-8940 or our Canandaigua office at (585) 394-0700 to verify whether your plan is included. Our staff is happy to help you!
If we do not participate with your plan, self-pay is also an option.
The rates for new patients and existing patients range in cost based on evaluations and treatments at your visit. For details about our payment policy (co-pays, deductibles, etc.), please refer to our Financial Policy Form. Be aware that laboratory and pathology fees are not included in our fees and are billed separately by those labs.
It may be required under your insurance plan to obtain a referral from your primary care physician before being seen by the dermatologist. Please contact your physician’s office for your referral before scheduling an appointment with us.