Patient Registration Packet
Thank you for choosing Southwest Skin Specialists, now a part of U.S. Dermatology Partners! We appreciate the opportunity to care for your health. Please begin the registration process by completing our forms. You have the option to fill the forms online or print the forms and fill them out by hand.
- Click here! to fill the forms online (preferred method). You can access this link on your desktop computer or mobile phone. No app is required. All your information will be submitted electronically, and you do not need to print the completed forms.
- Or print the Patient Registration Packet and fill it out by hand. Please remember to bring your completed forms to your initial appointment.
Please bring a valid photo ID, current insurance card, and a form of payment to your initial appointment. To expedite the check-in process, please arrive 10-15 minutes prior to your scheduled appointment time.
If the patient is a minor (under 18 years of age), the parent or legal guardian must be present at the child’s initial visit to sign the Consent to Treat Minors form. Without a signed consent form, we cannot legally treat a minor child. The form allows you to list other adults who can accompany your child or if your child can arrive unaccompanied to future visits. If you are unable to attend the first visit with your child, you may sign the notary version of the parental consent form. If you are the child’s legal guardian (not a parent), you will need to confirm this by providing legal documentation. This information will be kept in the child’s file.
Please bring a valid photo ID, current insurance card, and a form of payment to your appointment. To expedite the check-in process, please arrive 10-15 minutes prior to your scheduled appointment time.
We understand that sometimes you may be delayed. However, late arrivals may require rescheduling. U.S. Dermatology Partners reserves the right to charge a fee if the appointment is not canceled at least 24 hours in advance. Special types of appointments require a deposit to reserve the appointment date. U.S. Dermatology Partners reserves the right to charge a fee or retain the deposit if the appointment is not canceled at least 72 hours in advance.
- Arizona Foundation for Medical Care
- Blue Cross and Blue Shield
- United Health Care
Services that are not medically necessary, such as cosmetic procedures, are not covered by insurance. Patients are responsible for payment at the time of service. Healthcare financing with CareCredit is available to assist you with a payment plan.
We accept most major insurance carriers. However, please contact your insurance company prior to scheduling your appointment to verify the specifics of your coverage. Also, it is important to ask your insurance carrier if any referral, pre-authorization, or pre-certification is necessary before you schedule your appointment with us. HMO carriers require preauthorization prior to treatment.
- American Express
- Cash / Check
Payment is due at the time services are rendered. The amount collected is estimated based on benefit information available. Specific policy information is often limited or unavailable until after a claim has been filed. Insurance coverage is not a guarantee of payment. The patient is responsible for any remaining balance not covered by insurance.
Medical Record Request Form
If you are moving or transferring care, we are happy to send a copy of your medical record. Simply complete the Medical Records Request form and submit to our office.
The patient portal is a powerful tool you can utilize to view requested medical records, retrieve basic visit information and update your personal info.
Patient Handouts and Instructions
- Chemical Peel: Pre-Treatment and Post-Treatment Instructions
- Fraxel® Laser Treatments
- Intense Pulses Light (IPL) Photo Facial: Pre-Treatment and Post Treatment Instructions
- Preparation for Cosmetic Botulinum Toxin Treatment (BOTOX® Cosmetics, Dysport®)
- Preoperative Instructions
- Second Intention Healing
- Skin Graft Wound Care
- Soft Tissue Augmentation: Preparation
- Wound Care Instructions
– Performed at CALM Scottsdale
– Preparation and After Care Forms
- Fat Reduction with truSculpt iD
- AlphaRet Peels
- IPL Photo Rejuvenation
- Laser Treatments (Excel HR, CoolGlide, VariLite)
- Fractional Radiofrequency (RF) with Pixel8
- SkinPen Microneedling
- Soft Tissue HA Filler
- Superficial and Medium Depth Chemical Peels
- Fraxel Dual Laser Treatment (With Eyeshields)
- Fraxel Dual Laser Treatment (Without Eyeshields)