New Patients / Forms
Your first visit to Phoebe Rich Dermatology establishes a crucial foundation for our relationship with you. During the initial visit, we obtain your medical history and any other information that may be pertinent to maximizing the benefits of your visit.
During this first visit, you will begin by checking in with one of our receptionists; please bring in your insurance card, an ID card, and a current medication list. Once you have completed your paperwork, one of our medical assistants will bring you back to an examination room where they will review your paperwork, your previous dermatologic history, and your current dermatologic concerns (the reason you’ve scheduled your visit). After noting this information in your electronic file, they will leave the examination room and leave you to change into a medical gown. While you’re changing, they are presenting your information to the provider. When the provider arrives in your exam room, the medical assistant will also be with them so they can scribe for the provider. This allows the provider to give you (and your skin) their undivided attention while the medical assistant takes down all locations and descriptions into your electronic medical chart. Should medications be prescribed, we will do our best to send these to your pharmacy electronically. If time allows, we also aim to do small procedures at the same appointment.
Below you will find directions, office hours, and links to new patient paperwork. To save you time before your first visit, you can print out our paperwork and bring the completed forms with you to your appointment.
All new patients are required to fill out the Patient Registration, Health History, Notice of Privay Practices Acknowledgment, and Genetic Testing Participation forms. Depending on what issues you are being seen for, you may also be required to fill out the forms that relate to the specific reason for your visit.
If you are a returning patient, but have not had an appointment within 3 or more years, we ask that you please fill out a new Health History form and bring it with you to your visit. In addition to completed paperwork, feel free to bring anything else you think might help your provider better understand your concerns. This includes, but is not limited to, additional health histories, chart notes, and a list of any medications or topical treatments that you may be using at the time.
If you are coming in for the following, please be be aware:
- Acne – please arrive with no makeup
- Rash – make sure to bring in a current medication list
- Nails – please arrive with no nail polish or acrylics on your nails
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t health insurance or who are choosing to be self-pay an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health Edited 2/22 care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate and the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.
New Patient Forms
Please complete one of the below forms only if it pertains to the reason for your visit.