Forms

Forms

Patient Forms & Info

1. New Patient Registration Forms | Fill Out Online

2. New Spa Client Form | Fill Out Online

3. HIPAA Authorization for McLean Derm to Release Health Information | Fill Out Online

4. HIPAA Authorization for McLean Derm to Obtain Health Information from another Facility | Fill Out Online

5. Permission for a Minor to be Seen Without a Parent/Legal Guardian | Fill Out Online

6. Photo Consent Form for Release of Clinical Photos | Fill Out Online


Insurances & Billing

We are in-network providers for Carefirst Blue Cross Blue Shield, Cigna, Medicare, United Healthcare, Virginia Health Network, and PPO plans through Anthem Blue Cross Blue Shield.

We are out-of-network providers for all other health insurance plans and we do not accept them. We do not submit claims for insurances that we do not accept (out-of-network insurances).

Payment for all visits which are not submitted to insurance is due in full at the time of service. We accept Visa, MasterCard, Discover, and American Express credit cards. We do not accept checks.

If your insurance requires referrals or pre-authorizations in order for your services to be covered, you must obtain these prior to your visit.

If you have questions about your bill please contact our billing department at 1-800-300-7819.


Get Social! Share Forms

AS SEEN IN

As Seen On As Seen On

Join Our Newsletter!