For Patients

For your convenience, we have provided the following forms which you can download, print, and complete prior to visiting our office. Please write legibly and check the accuracy of your information that you provide.

Payment Options:

We accept Mastercard, Visa, Discover, American Express, and cash.
We do NOT accept checks.

Accepted Insurance Carriers:

We accept most major carriers, including:

• Aetna
• Blue Cross Blue Shield
• Cigna
• HealthNet
• Medicare
• United Health Care

We also accept other plans that are not listed. Please contact our billing office if you have questions about your specific plan.

Patient Forms

Please bring the following completed forms to your visit:

• Medical History Form
• Financial Policies
• Patient Information

Please remember to bring the following to your appointment as well:

• Driver's License
• Insurance Card

Established Patients

If your contact information or medical history (including medications) has changed, please bring the appropriate completed form(s) to your visit:

• Patient Information
• Medical History Form

If you have not been seen by a provider at English Dermatology in over one year, please bring the completed form to your visit:

• Medical History Form

Medical Records

If you need a copy of your medical records forwarded to another provider, please complete and submit the following form:

• Medical Records Release

Please note that additional charges may apply to fulfill your request.

Consent For Minors

If you are the parent or legal guardian of a patient who is a minor, and you will allow the patient to be seen by a provider without his or her parent or legal guardian, please complete and submit the following form:

• Consent for Minors

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.