FORMS AND POLICIES

New Patient Information and Medical History Forms

While you are in our office, you will be asked to complete this New Patient Information and Medical History Forms.

To save you time, click on the button to upload these forms in printable format, print it, fill it out, and bring to the office.

• New Patient Information Form [pdf]
• Medical History Form [pdf]

Policies

Office Policy and Patient Information

Dr. Norman and his staff sincerely welcome you to our office and appreciate the confidence you have placed in us.

Philosophy

To provide in an understanding and thorough manner the best dermatology health care available for your individual needs.

Goals

• To preserve the natural skin for a lifetime of service and attractiveness.
• To educate you in preventing harmful diseases of the skin.

The above goals can only be achieved with the understanding and cooperation of our patients.

Appointments

The exact amount of time needed is reserved for each patient’s particular needs. To enable us to complete treatment within your appointed time, your promptness is necessary and appreciated.

A reminder card will be given to you by the receptionist. Please bring this card with you at the time of your appointment. As a courtesy to our patients, our staff will attempt to remind our patients of their appointment by telephone one or two days prior when possible. Do not depend on this reminder. It is the patient’s responsibility to keep the appointment. If your insurance company requires pre-authorization for procedures, please call the day before your appointment to make sure authorization was given.

To cancel your appointment, our office requires a minimum of 24 hours notice prior to your appointment time. This will enable us to schedule other patients who also need treatment. Failure to notify our office of cancellation of an appointment will result in a financial charge.

For emergency services, please go to the nearest Emergency Room.

Infection Control

In our office, we welcome your questions about AIDS and our infection control procedures. We want you to be comfortable knowing we are using all steps necessary to assure that your visit is a safe one. We adhere to what is called “universal precautions." That means we use the same protective measures with every patient to prevent transmission of the virus that causes AIDS or any other infectious disease. Your health is our number one concern. All non-disposable instruments are scrubbed and disinfected.

Financial Arrangements

Payment is expected for treatment at the time services are rendered. We accept personal checks, cash, Master Card and Visa as methods of payment.

Children

Dr. Norman sees children of all ages. Children under 18 years of age require a parent or guardian present.

Health History and Medications

For your safety and comfort, it is vital Dr. Norman be aware of all medical complications as well as all drugs currently being used by the patient. Please keep our office up to date about any changes.

Staff

Physician: Dr. Robert Norman
Other Health Professionals on Staff: Physician Assistant, Advanced Registered Nurse Practitioners

NOTICE OF PRIVACY PRACTICE

This information is made available to all patients.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY HAVE ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE GENERATED BY THIS PRACTICE, WHETHER MADE BY THE PRACTICE OR AN ASSOCIATED FACILITY.

This notice describes our practice’s policies, which extend to:

• Any health care professional authorized to enter information into your chart (including physicians, Pas, RNs, etc.)
• All areas of the practice (front desk, administration, billing and collection, etc.);
• All employees, staff and other personnel that work for or with our practice;
• Our business associates (including a billing service, or facilities to which we refer patients), on-call physicians, and so on.
The Practice provides this Notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

 

Miscellaneous

Credit Cards Accepted: Visa, MasterCard, Amex, Discover
Accepting New Patients: Yes
Languages Spoken: Spanish
Nursing Home Visits: Yes
Handicapped Accessible: Yes
On Major Transportation Route: Yes
Primary Specialty: Dermatology
Secondary Specialty: Family / General Practice
Clinical Interests: General Dermatology, Mohs Surgery, Geriatric Dermatology

Summary

Our office is constantly striving to improve all aspects of what we do for you. Your comments, positive or negative, help us evaluate ourselves.

We thank you for selecting us for you skin care needs. If you have any questions pertaining to our office or your treatment, please don’t hesitate to ask. We firmly believe the more you are informed, the more you will appreciate our office.

Again, thank you for the confidence you have placed in us.