Your Visit

When calling to make an appointment, please have the following information available:

  • Name
  • Date of Birth
  • Address and Phone Number
  • Insurance Information
  • Referral Information
  • Primary Reason for Visit

Please note that Peraza Dermatology Group and the front desk staff will not be able to quote exact prices prior to your appointment.

Please plan to arrive to our office 15 minutes before your scheduled appointment to check-in and complete required paperwork. We ask that you provide all of the listed items below when visiting the office:

  • Insurance Card: All patients who will be using their insurance coverage are required to bring their current insurance card to each office visit.  A copy will be made and placed into the patient’s chart. If the patient does not have their insurance card, the patient will have to cancel or be seen as a self-pay patient.
  • Identification Card: ID cards will be required at each office visit. A copy will be made during the first visit and placed in the chart. However, photographic identification may be requested at subsequent visits to the office.
  • Co-pay for insurance patients and full payment for self-pay patients: Patients who have a co-pay as part of an agreement with their insurance carrier will be required to pay prior to leaving the office for each visit. It is the patient’s responsibility to bring an approved method of payment, as listed in the payment options and policies section. The appointment will be cancelled if the patient does not bring appropriate means of payment.
  • Authorization and/or Referral forms (if required by your insurance): Authorizations/referrals are an arrangement between patients and their insurance carrier. Many health insurances require a referral or preauthorization for specialty services. Dermatology is a specialty service.  Authorizations/referrals are required prior to treatment. It is the patient’s responsibility to bring a copy of their authorization/referral from their primary care doctor to our office.  If a patient does not bring their authorization/referral with them, then their appointment will be cancelled and the patient will have to reschedule or be seen as a self-pay patient.
  • A Legal Guardian (if you are not of legal age): All minors are required to have a parent or legal guardian present with them at the time of their visit. By law, we are required to have consent from a legal guardian to provide most treatments to minors.  For your convenience, you may download our Treatment to Minors Form.  If a minor patient comes to the office unattended, the minor may be required to cancel or reschedule.
  • A list of your current medications

Please note that if you do not bring the following items with you to your visit, we reserve the right to reschedule or cancel your existing appointment.

Peraza Dermatology Group will file claims directly with the patient’s insurance carrier for services where covered benefits have been verified.  Insurance verification does not guarantee the patient’s insurance will pay for services. It is the patient’s responsibility to know if our physicians are considered “in-network” by the patient’s insurance. Payment is due within 30 days of receipt of a statement sent from our office.

Authorizations/referrals are an arrangement between patients and their insurance carrier. Authorizations/referrals are required prior to treatment. It is the patient’s responsibility to bring a copy of their authorization/referral from their primary care doctor to our office.  If a patient does not bring their authorization/referral with them, then their appointment will be cancelled and the patient will have to reschedule or be seen as a self-pay patient.

Payment of co-insurance, co-pays, deductibles or fees for non-covered services, when applicable, is required at the time of service. We accept cash, checks, health debit cards, money orders, cashier’s checks, and DISCOVER, MASTERCARD and VISA credit/debit cards.

All cosmetic and laser appointments require a $100.00 non-refundable deposit that will be applied to your service fee on the day of treatment. In the event that you cancel your scheduled appointment within 48 hours, the deposit will be refunded.

Some surgical pathology and other lab specimens are submitted to outside laboratories for analysis and/or slide preparation. These services represent an additional fee charged to you by an outside office. Second opinions are obtained when the physician feels it is necessary to provide optimal care. As a patient, you understand that you may receive a separate bill from an outside hospital facility or laboratory such as: Mid Atlantic, DHMC, Borstings Laboratory, Quest, etc.

It is the patient’s responsibility to check these conditions prior to their appointment and bring an approved method of payment. The appointment will be cancelled and rescheduled if you do not bring appropriate means of payment. In special circumstances, Peraza Dermatology Group will offer payment plans to those who are unable to pay their balance in one full payment.

Our office attempts to contact all patients prior to scheduled appointments. If you are unable to keep an appointment, we kindly ask that you provide us with 24 hours notice. A $50.00 no show/cancellation fee will be applied to all patient accounts when an appointment is not cancelled at least 24 hours prior to the scheduled appointment. This courtesy, on your part, makes it possible to give appointments to other patients.

Patients must cancel all cosmetic and laser appointments 48 hours prior to one’s scheduled appointment to receive refund of deposit.

The following forms can be downloaded to your computer and printed at home. In order for our doctors to provide a complete and comprehensive medical evaluation, it is important that the physicians review all of your medical information. Please be prepared to provide this information to our office along with your current medical insurance information. Below are links to our patient registration and office forms. If you have any questions when filling out these forms, our staff will assist you on the day of your visit.

Patient Registration Forms
HIPAA Privacy Policy Form
Office Policy Consent Form
Patient Information Sheet
Treatment to Minors Form

Office Forms
Medical Records Release Form (TO Peraza Dermatology Group)
Medical Records Release Form (FROM Peraza Dermatology Group)
Patient Questionnaire

Please call our prescription line at 603.542.6455 x 5 for all prescription refills.

Our physicians normally prescribe sufficient refills to last patients until their next follow-up appointments. If you, the patient, need a refill and do not have a scheduled appointment, please call our prescription line at 603.542.6455 x 5. The physician will review the request, and if you need to be seen prior to a refill, our staff will call to schedule an appointment. Otherwise, please allow our office 72 hours to process your request.

 

 

Please Note: These policies are subject to change periodically. The most updated policies will be presented to you at the time of your visit.