Please plan to arrive 15 minutes before your appointment and bring your new patient forms with you.
(Please remember that your health insurance is a contract between you, your employer and your insurance carrier)
- Co-pays are due at the time of your visit and are collected when you check in. If you cannot pay your co-pay, we will ask that you reschedule your appointment.
- Please contact your insurance company if you are unsure of your benefits.
If there is a question of financial responsibility, the parent or legal guardian that accompanies a minor to see a doctor will be responsible for the account.
First Visit Forms
To expedite your check in time on the first visit, feel free to print the following forms, fill out completely, and bring them with you to the office for your first appointment. We will also need to copy any insurance card you have coverage under, and a photo ID.
- Patient Info Form
- Medical History Form
- Skin Cancer Screening Form
- Medicare Authorization Form (if you are covered under Medicare Part B)
- HIPPA Notice of Privacy Practices
Your insurance card is needed prior to being seen. If you cannot provide us with your insurance information, you will be asked to reschedule your appointment or pay for the visit on the day of service.
- Please call the office at 317-875-6880 if you know you are going to miss an appointment, or be late. This would allow another patient the opportunity to be seen.
- If you are scheduled for surgery, a procedure or Accutane follow-up, and you cancel or no show, we may not be able to reschedule another appointment in a timely manner. If you are on Accutane, you may run out of medication before we can get another appointment scheduled for you.
- To cancel an appointment, please call 24 hours beforehand and if you have a surgery or procedure scheduled, please call 48 hours in advance.
- Our practice accepts cash, personal check, Visa, Master Card and money orders. We do not accept American Express or Discover cards.
- Some diagnoses might be considered cosmetic and may not be covered by your insurance company. If that is the case, we require payment on the date of service. If you have any questions regarding your coverage, please contact your insurance company.
Any patient who comes in for an appointment without their referral (if their insurance company requires one), will have to pay for that day’s visit, or reschedule for a later date.
Children and young adults under the age of 18 will need to be accompanied by a parent or legal guardian on their first visit. Our doctor is not able to see small children without a parent or legal guardian present. Once the initial visit has been completed, young adults of driving age can be seen without their parent or legal guardian for routine checkups. If the young adult of driving age requires a procedure or is starting Accutane, a parent or legal guardian needs to be present to give consent.
We will accept payment for services rendered on the day of service.