Thank you for being our patient.
Below you will find new patient forms. We are honored you have selected Advanced Dermatology & Skin Cancer Center, PLLC to be the dermatology provider for you and your family.
The following patient forms can be downloaded and printed at home. By filling out these forms ahead of time, you will save time during your visit. Please be prepared to provide this forms to our office along with your current medical insurance information and identification. If you have any questions when filling out these patient forms, our staff can assist you with your questions on the day of your appointment. You will also receive a link through text message to complete these forms.
If you are a new patient, please print and complete the patient forms below to bring to your appointment:
If you are a new patient, click here to download the forms.
Late Arrival Policy
Advanced Dermatology & Skin Cancer Center, PLLC is dedicated to providing the highest quality care for our patients in a timely and efficient manner. In an effort to maintain that efficiency, we attempt to contact every patient at least 24 hours prior to their appointment as a courtesy reminder via text or e-mail, if you have these notifications turned on. Here are directions to each of our clinics.
Our doctors, medical staff, and front desk aim to make your visit a pleasurable one. In our efforts to minimize your wait time, our clinics have implemented a late arrival policy. If a patient is more than 10 minutes late for an appointment, the appointment may need to be rescheduled. This is to ensure that the patients who arrive on time do not wait longer than necessary to see the provider. A patient who is late may be given the option to reschedule or be seen as a walk-in on the same day on a first come first serve basis, if the provider has room in their schedule. We will try to accommodate late arrivals as best as possible. It does speed up check-in if you either bring in your completed new patient forms or complete them from the link we will text you. You can also upload a picture of your insurance at the same time.
Cancellation/No Show Policy
If you are unable to keep your appointment, please provide our office a minimum of a 24 business hour notice. Cancellations for Monday appointments must be received by the Friday prior. This allows us to fill your appointment with another patient. To assist you, we send out notifications to confirm your appointment before your appointment date, as long as we have your current email address and cell phone number.
There will be a $100.00 fee if you fail to keep any Cosmetic Dermatology, Mohs Surgery, or Dermatologic Surgery appointments without the 24 business hours prior notification. Your insurance does not cover the fee for no-show visits – you are fully responsible for the no-show fee. Also, note that is you have 3 no shows in one-year, you will be discharged from the practice and no longer to schedule appointments with our providers.
We realize life does get in the way sometimes. Please call our office as soon as you are aware you missed an appointment.
Dermatology, Mohs, and Surgery appointments – (479) 718-7546
Cosmetic appointments – (479) 287-4738
A $100 prepaid fee is required for any cosmetic consultations. This fee goes towards any product or treatments purchased as a result of the consultation. This fee is nonrefundable.
The balance for any cosmetic procedure is to be paid at the time of service. Some procedures may require a complete payment in advance or a deposit. You may call our office at 479-718-7546, select option 2 or extension 516. There will be a $100 charge for all cosmetic appointments that are not canceled at least 24 business hours in advance to the appointment.
Prior to your surgery, the billing staff will verify your benefits. They will call/mail you a letter explaining your responsibility according to the benefits quoted by your insurance company. A surgery deposit will be required five (5) business days before your scheduled surgery date. If you have a delinquent balance on your account, it will need to be paid before you can make an appointment.
If you have a biopsy and require a pathology report, there will be a separate bill. Once a diagnosis has been determined and a Pathology report has been received in our clinic, your charges are billed to your account. Your statement may be from our office/outside pathology office, depending on your diagnosis.
Any product is to be paid for on the date of purchase. All product sales are FINAL; No returns or exchanges are allowed.
Advanced Dermatology & Skin Cancer Center, PLLC, downloadable policy documents:
Online Bill Pay
For your convenience, we also offer online bill pay. Please enter the amount you wish to pay in the box below and click “Click to Proceed” to go to the next step. In the next step, you will enter your Customer ID number and additional information.
Your Customer ID is your Account Number on your statement. If you are pre-paying for a surgery, please call (479) 718-7546 ext. 517.
Thank you for your payment.
Once you enter the amount you wish to pay, click the button “CLICK TO PROCEED” to be redirected to our payment processing page to complete the transaction and ensure it is properly attached to your account.
*NOTE: You will enter your Account Number in the “Customer ID” field on the payment processing page.