New Patient Registration Information
In an effort to expedite the check-in process for new patients and to
reduce your waiting time at Melbourne Dermatology Center, please download
the appropriate PDF file, print them out, then complete and sign. Be
sure to bring them with you when you come for your appointment.
We're looking forward to seeing you soon!
The latest Adobe Reader software is required to view the forms and is
available for download free at www.adobe.com
For Medical visits, as a courtesy to our patients, we will bill your
insurance company on your behalf. We recommend that you review your
specific insurance plan for co-pay, deductible and other benefit information
prior to your office visit. The insurance plans we accept are listed
below. This list updated continually; however, please call the front
office (321) 724-9650
for updates or changes prior
Please bring your insurance card and prior authorization information
with you to your appointment.
You may be responsible for the following charges at the time of your
• Annual insurance deductible
• Coinsurance amounts (due at time of check-in)
• Charges for services and supplies that are not covered by
your insurance plan
• Any services denied by insurance
• Cosmetic services
Insurance Plans Currently Accepted:
• Health First
• BCBS of FL
• United Healthcare
Government Insurance Plans:
Cosmetic services are not billable to insurance.
For non-insurance visits, payment for cosmetic and non-cosmetic services
are due in full at the time of your office visit.
We accept Visa, Mastercard, American Express, cash and checks for
Insufficient funds (bounced check) policy: patient will be billed
amount due plus $30 per occurrence.
Missed appointments will be billed $25.00, not applicable if cancellation
24 hours in advance.