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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.

Patient Registration Packet

Medical/Surgical History

Privacy Practices HIPPA

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

Contracted Insurances

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 your visit.

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 office visit:
• 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:
• Aetna
• Health First
• Cigna
• BCBS of FL
• Humana
• United Healthcare

Government Insurance Plans:
• Medicare

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 payment.

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.



 


Office Hours


Monday thru Thursday

8:30 am – 5:00 pm

Friday
8:30 am – 12 noon



 


Our doctors and staff enjoy caring for patients of all ages. We consider it a privilege to provide care for several generations of families.

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Melbourne Dermatology Center 333 East Sheridan Road Melbourne, FL 32901