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We are so pleased that you have chosen Premier Dermatology and Skin Renewal Center for your dermatology care. We see your treatment as a team approach and request the following form you to make your experience as effective and efficient as possible:
1. Please promptly arrive 10 minutes before your scheduled appointment if you are an established patient and 20 minutes before if you are a new patient.
2. If you are more that 20 minutes late for your appointment you may be asked to reschedule so as not to inconvenience those patients who arrived on time or their appointments.
3. Please have all of your insurance information and a valid insurance card with you at each new and established appointment, so that we can insure that your visit is filed in a correct and timely manner.
4. If your insurance company requires a referral, we will not be able to schedule an appointment until the referral has arrived at our office. Please check with your insurance carrier and your primary care physician to ensure that the referral is sent to us. If a referral has not been received, we will be glad to see you; however you will be responsible for paying the entire balance of the charges for your visit on the day of the appointment.
5. Payment is expected on the date of your appointment. This includes insurance co-payments, any deductible amount unmet and charges for any cosmetic procedures performed.
6. If you have an outstanding balance, you will be expected to pay this balance before see the doctor. If you are unable to pay that day, we will be glad to reschedule your appointment.
7. If you are scheduling a future appointment that will require more than 30 minutes of Dr. Clifton or her staff's time, you will be asked to provide a credit card deposit of $50.00 to schedule. If you fail to keep the appointment or fail to cancel with at least 24 hours notice, your credit card will be charged $50.00 which will not be applied to charges and will not be refunded.
8. If you have anything less than a wonderful experience here at Premier Dermatology, Dr. Clifton requests that you politely let her or our staff know as soon a possible so that we may rectify any problems within our office. Our staff is committed to providing you with only the best care.
Thank you for your help and cooperation!
Dr. Missy Clifton and Staff