New Patient Information

New Patient Information

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.

Patient Forms & Info

New Patient Registration | Fill Out Online

Permission for a Minor to be Seen Without a Parent | Fill Out Online

Photo Consent Form

HIPAA Form – McLean Derm Releasing Info | Fill Out Online

HIPAA Form – McLean Derm Obtaining Medical Records from another Facility | Fill Out Online

Insurances & Billing

We are in-network with most PPO plans through Blue Cross Blue Shield, Coventry, United, and Medicare.

We are out-of-network with all other health insurance plans, and therefore do not accept them. We do not submit claims for out-of-network insurance plans. 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 you have any questions about your bill for a visit before 10/13/16, please call Dermatology Billing Associates at 1-800-318-3271.

If you have any questions about your bill for a visit on or after 10/13/16, please call: 1-800-300-7819.

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Schedule an Appointment

To schedule an appointment, call (703) 356-5111.

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