Patient Forms & Info
1. New Patient Registration Form – ADULTS (AGE 18 AND OVER) | Fill Out Online
2. New Patient Registration Form – MINORS (UNDER AGE 18) | Fill Out Online
3. New Spa Client Form | Fill Out Online
4. HIPAA Authorization for McLean Derm to Release Health Information | Fill Out Online
5. HIPAA Authorization for McLean Derm to Obtain Health Information from another Facility | Fill Out Online
6. Permission for a Minor to be Seen Without a Parent/Legal Guardian | Fill Out Online
7. Photo Consent Form for Release of Clinical Photos | Fill Out Online
8. Latisse Consent Form | Fill Out Online
9. Upneeq Consent Form | Fill Out Online
10. Request For Meeting With Providers | Fill Out Online
Insurances & Billing
We are in-network providers for the following insurance plans:
- Anthem BCBS except Anthem Health Keepers
- Cigna (Open Choice Plus and Connect)
- First Health
- United Healthcare
Insurances REQUIRED to have an insurance referral:
- Cigna Connect
- Cigna EPO
- United Healthcare Optimum Choice Plan
- All HMO Plans
We are out-of-network providers for all other health insurance plans and 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. All sales are final. 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 your insurance requires a referral for your visit and it is not processed and received by our office prior to your visit, you will likely need to reschedule your appointment.
We use third-party labs for biopsies, blood work, and cultures. If your insurance requires use of a specific lab in order for laboratory fees to be covered, you must notify us about this prior to your visit.
If you have questions about your bill, please contact our billing department at 1-800-300-7819.