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Patient Information
Patient Information
Preparing for Your Visit
The entire staff at Commonwealth Dermatology aims to see our patients in a timely manner because we care about your time. In addition to completing the forms below, we also ask the following:
* PATIENTS UNDER THE AGE OF 18 MUST ARRIVE WITH A LEGAL GUARDIAN
* Please arrive 15 minutes early prior to your scheduled appointment time
* Please bring your insurance cards, photo ID, and any applicable referral
* Any copay, coinsurance or deductible is collected at the time of visit.
Refunds are issued after insurance(s) have been processed.
* If you are unable to make your appointment please provide 24 hours notice by calling or sending a portal message. Failure to do so could result in a $75 no-show fee.
General Dermatology:
Please complete these forms if you have not been seen within the current calendar year or changes have occurred.
Referral Information:
Patients being referred to Commonwealth Dermatology will need to have this form completed by the referring provider. Attach this form to all corresponding documentation and fax to the practice, 804-288-7135, prior to your appointment
Insurance
Aetna - PPO, American Continental
Anthem BC/BS & Healthkeepers
Cigna - PPO, Health & Life, Great West, Mid-Atlantic
MDIPA Optimum Choice UHC
Medicaid - Straight, Aetna Better Health, Anthem Healthkeepers Plus
Medicare
Medicare Advantage PPO's - Anthem, Humana, United HealthCare
Railroad Medicare
Sentara - Commercial
Humana Military Tricare
Tricare for Life
United Healthcare
Multiplan including Private Healthcare Systems (PHCS)
Virginia Health Network
GEHA
Humana HMO
Anthem Medicare Advantage HMO
Are you ready to take the next step?
Get In Touch
To request an appointment, please fill out the form below and we will contact you about availability. Please allow us up to 48 hours to process your request.