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Warren Skin Care Center

NEW PATIENT FORMS

PRIVACY PRACTICE NOTICE

Referral Policy

 

Your insurance policy is a contract between you and your insurance company; therefore it is your responsibility to know how your benefits work. Please make sure we have a copy of current primary and secondary insurance. You are responsible to update any insurance changes and to know if you need a referral. If a referral is needed, you are responsible to obtain the referral from your primary doctor prior to the appointment. If it is not available at time of appointment, you may either pay for the visit at the time of service, or change your appointment to a later date so you may obtain the referral/authorization.

  RECORD RELEASE FORM  

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