Patient Info & Forms

New Patients are required to review or complete several forms.  These forms are listed below for patients to print, review, and fill-out.  Please bring all completed forms to your first visit.  Please also remember to bring a medications list of what you use, or take a picture of them if easier.

For complete skin exams: No self tanner applied several days before your appointment so moles can be clearly seen.  And please no nail polish so your nails can also be checked for skin cancer.  Please be aware for biopsies: starting in 2021, we do our best to do biopsies the same visit as your complete skin check.

*Please bring your insurance card + picture ID to your appointment.*

Self-Pay:
If we don’t take your health insurance, or you don’t have insurance, we are able to take you as a self-pay patient.

If you are out-of-network, you may contact your insurance carrier to see if you have any out-of-network benefits, and receive instructions on submitting your receipt to your insurance carrier for those benefits.

Please let us know you are self-pay when calling. 

Insurances accepted:

  • BCBS State Health Plan of North Carolina (no other BCBS Plans accepted).  State Health Plan member IDs typically begin with YPY.

Insurances NOT accepted (patient would be seen as self-pay out-of-network):

  • BCBS plans (EXCEPT for State Health Plan, which we *are* in-network with)
  • UHC
  • Aetna
  • Medcost
  • Medicaid
  • Humana
  • Medicare Advantage HMO (BCBS, Aetna, Cigna, UHC, etc)
  • Tricare
  • Cigna
  • Medicare

If your insurance is not accepted, you may still be seen as a self-pay patient.

Waiting List:

If you would like to be seen sooner than your appointment please ask our scheduling staff to put you on the waiting list and you will be called as soon as any cancellation appears.

Forms: