New Patient Forms
Dear New Patient,
Thank you for choosing Jacks Dermatology, P.A. as your skin care health provider. At Jacks Dermatology, you will be welcomed by a caring and hospitable staff whose goal is to make your visit as pleasant as possible. Please feel free to print and complete our New Patient Forms. Please bring completed New Patient Forms, a photo ID, and insurance cards to our office on your scheduled appointment date and time. If you take medications please complete the medications section on the Dermatology Medical History form. Medication lists can be brought to the office to be copied.
Appointments - At Jacks Dermatology, we strive to see all our patients in the most timely and convenient manner possible. As a courtesy, we attempt to contact all patients at least one day prior to their scheduled appointment to remind them of the date and time. If you are unable to keep your scheduled appointment date and time, please give our office a call so that we may offer this time to another patient in need of care. Patients that do not contact the office prior to their missed appointment will be marked as a “no show” and a charge of $25 may be applied.
Location and Office Hours - Our office is located behind JRMC on 42nd Avenue. We are tucked right behind The Drug Room Pharmacy neighboring Dr. M. A. Pashkevich office. Our office hours are Monday - Friday 8:00am to 5:00pm.
Insurance - For the benefit of our patients we accept most insurance. You may want to check with your company to verify if our provider is on their list. As part of our contract with insurance companies we are legally required to collect co-pays and deductibles from you at the time of service. We ask that you be prepared to pay your co-pay at the time of the visit. We will accept cash, check, money order, or credit card. We also accept patients with no insurance.
Biopsy and Lab Work – You will receive prompt notification of any results that are normal or abnormal in a timely manner. Biopsy and lab work that is collected in-office will be sent to another facility to be tested and will be billed separately by that facility.
Medications and Refills – Medications will be sent to your pharmacy electronically. For refills, please contact your pharmacy to send our office a refill request.
Once again, thank you for choosing Jacks Dermatology, P.A. as your skin care health provider. We are looking forward to meeting you and caring for all your dermatological needs.
The Staff at Jacks Dermatology, P.A.