Battle Creek, MI 269-660-1670
Kalamazoo, MI 269-342-2991
Jackson, MI 517-787-5350
Sturgis, MI 269-651-1670
Angola, IN 260-665-1670
Hillsdale, MI 517-437-2490
To reduce time for your first visit, please print the appropriate forms. Fill them out and bring them along for your appointment. The team at Dermatology & Skin Surgery Center, looks forward to helping you.
Patient Registration Form - All new patients will need to complete this form for basic information.
Privacy Acknowledgment - All new patients will need to complete this form. To read the Privacy Practices, click on the “Notice of Privacy Practices”. Or you may request a copy to read once you arrive at the office.
Patient Insurance / Payment Information Form - If you do not have Medicare, you will complete this form.
Medicare Information Form - If you have Medicare or Medicare and a Medigap (Medicare supplemental policy) you would complete this form.
Take the time you need to get all your information correct before you come in; make sure you have your insurance information correct, and all of your contact information.
You will need to fill out each form in full before you can turn them into the front desk staff; we need copies of the Patient Registration form, Privacy Practices form, Insurance Payment form, and if it's applicable to you, the Medicare Form.
Get started today.