1419 Village Drive
St. Joseph, Mo 64506
ADVANCED DERMATOLOGY & SKIN CANCER CENTER
| 816.364.1507 |
2617 Burris Road
Maryville, Mo 64468
New Patient Registration Forms
The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit.
If you do not have a copy of Acrobat Reader you can get one for free by clicking ‘Get Acrobat® Reader‘. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.
Please be prepared to provide this information to our office along with your current insurance information.
If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.
We accept the following payment methods: Cash, Check, Master Card, Visa, Discover, & American Express. For Your Convenience, you can also pay through Patient Portal by clicking button below.
Watch this video for a tutorial on how to pay your bill.
APPOINTMENTS
New patients are asked to arrive fifteen minutes early to fill our forms for the medical chart. Please have insurance cards ready so that we may make a copy for our billing needs.
In order to better serve you, please be sure to inform the receptionist of any changes to your address, phone number or insurance plan.
For your convenience, click here to download the "New Patient Registration Form".
As a courtesy you will receive an automated call to remind you of your scheduled appointment 48 hours in advance. To better accommodate the needs of our patients, we request a 48 hour notice if you are unable to keep a scheduled appointment.
We look forward to meeting you and assisting you with your healthy skin journey.
NEW PATIENT REGISTRATION
Please download the "New Patient Registration Form" to your computer and print at home, by clicking button at bottom of this column.
If you do not have Acrobat Reader you can get one for free by clicking here.
This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.
By filling out these forms ahead of time, you will save a significant amount of time during your visit.
Do the best you can to fill out the form, then our staff will assist you with any questions on the day of your visit.
Please be prepared to provide this information to our office along with your current insurance information.
INSURANCE , BILLING,
FINANCING OPTIONS
We accept most traditional insurance plans. Please contact your insurance provider to verify acceptance of your plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure. We are happy to file insurance for your reimbursement as long as you are free to choose your own dermatologist. You are responsible for a co-pay at the time of your visit.
Cosmetic services will not be submitted to insurance and are due at the time of service. For billing questions, please call (816) 364-1507 ext.6 to speak with a member of our billing staff.
Care Credit Financing Option:
CareCredit can help you cover your deductible, or pay for treatments and procedures not covered by insurance*, it helps make the health, wellness and beauty treatments and procedures you want possible today.
*Subject to credit approval.
Schedule Your Appointment Today
