Cosmetic Dermatology Manhattan

Patient Information

Patient Forms

The following forms can be downloaded to your home computer and printed out. Filling out these forms beforehand will save a significant amount of time during your visit. Present completed forms along with your current medical insurance information and a photo ID when you check in for your appointment. 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.

  Patient Registration

Need Adobe Acrobat Reader?

If you do not have a copy of Acrobat Reader you can get one for free by clicking on the icon 'Get Acrobat® Reader'. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

New patients

Please complete the above mentioned Patient forms and arrive 15 minutes prior to your scheduled appointment with your insurance card, photo ID and, if required by your insurance company, a valid referral.

Existing patients

If you have not been to the office within the past 12 months, please download, print and complete the above mentioned Patient forms prior to coming to the office. Remember to bring your current insurance card, photo ID and, if required by your insurance company, a valid referral.

Referrals

Some insurance companies require a referral for specialist visits, which is obtained from your Primary Care Physician. It is the patient’s responsibility to bring in a valid referral on the date of his/her appointment.

Cancellation Policy

If you are unable to keep an appointment we require that you provide us with at least 24 hours notice. To cancel or change an appointment you must speak directly to a receptionist, leaving a voicemail on the phone is not considered a cancellation. Failure to cancel or reschedule an appointment 24 hours in advance will result in a fee of $50.00.



Payment Options

Payment is due at the time of service. If we participate in your insurance plan the estimated patient portion is due at the time services are rendered. Please call our office for more information at 212.242.5815.

The following credit cards are accepted for payment:

CHECKS NOT ACCEPTED



Accepted Insurances

We participate with the following insurance carriers. Although we make every effort to update this information frequently, you should call your insurance company to verify our participation. You may also contact us at 212.242.5815 with any questions.

  • 1199
  • 32 BJ (BCBS)
  • AARP
  • Anthem (BCBS)
  • Aetna - HMO
  • Aetna - PPO, POS
  • Aetna - EPO, OPEN ACCESS
  • BCBS (PPO, EPO, POS, Federal, Direct)
  • BCBS (HMO, Direct Pay HMOs)
  • BCBS Mediblue Magnacare Amerigroup
  • Cigna Benefice Advantage
  • Cigna PPO, HMO, POS
  • Consumer's Health Network
  • Empire Government (UHC, PPO)
  • GHI
  • Great West (NOW CIGNA)
  • Horizon Healthcare of NY (BCBS)
  • Medicare (NO MEDICAID GHI, BCBS, or MEDICAID)
  • Multiplan
  • Mutual of Omaha (PPO)
  • Oxford (FREEDOM, LIBERTY, SELECT, MEDICARE)
  • PHCS
  • Pomco
  • Unicare
  • Union Labor Life/ Cigna

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