Your first visit to Buckeye Dermatology, Inc. involves a few special steps so that we can get to know you. To understand what to expect, please read through this page.
Prior to Your Visit
Download our registration forms below and complete prior to your first visit. Please bring these forms as well as your insurance card(s) and a photo ID and provide them to the front desk staff upon arrival.
If you are unable to open the forms or print them out, please come to your appointment 15 minutes early to complete them at the office.
You will receive an automated call 3 business days prior to your appointment as a courtesy reminder (please listen to options because it does ask for a response).
If you are unable to keep your appointment, please give us a 24 hour notice for regular doctor appointments and 48 hours for surgical or cosmetic appointments. This allows us to offer that time slot to others who may be waiting for an opening. If you fail to give us the advance notice stated above, this will result in a no-show fee.
If the patient is a minor, a parent or legal guardian needs to be present for treatment. If no one is able to accompany the minor, please call the office to make arrangements.
To provide the best care, we need to know about your medical history. Make sure you are familiar with any previous skin conditions or procedures you have, as well as other significant medical conditions, allergies, etc. Have a list of all medications you take or have recently taken.
We look forward to your first visit!
New Patient Forms / HIPAA Forms
Please print and fill out the following forms and bring with you to expedite your first visit:
- New Patient Information Form
- Financial Policy Form
- Privacy Rule Form
- Consent for Use and Disclosure of Health Information Form
Other Patient Forms
(Do not need to fill out for your first visit)
- Parental Consent Form
- Authorization for Release of Information Form*
*(There may be fees associated with this record release)
- Notice of Privacy Practices
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
Map and Directions
View Buckeye Dermatology in a larger map