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New Patient Information
Welcome to Mid-Michigan Dermatology, PLLC.
We are looking forward to seeing you in our office. Please download our Medical Intake Form, fill
out and return to our office prior to your appointment.
You can fax your completed form to our office at (517)886-2072 or mail your
completed form to: MMD, 416 South Creyts
Rd. Lansing MI 48917
We MUST
receive your completed Medical Intake Form PRIOR
to your appointment or you may be asked to reschedule. If you are unable to send in the paperwork
prior to your appointment, please arrive 30 minutes early.
We also have maps
for you to print to help you locate our offices.
For your first appointment here we will need for you to arrive 15 minutes
early. During that time we will collect your completed forms, photocopy your
insurance cards and drivers license for your chart. You should plan to be at
our office for at least an hour.
If your insurance requires a referral for the appointment, you must present
the referral upon arrival or we will have to reschedule the appointment.
If we do not participate with your insurance, you will be responsible for
all balances not paid by your insurance company. For a complete list of insurances
that we participate with please click
here.
Insurance deductibles and copays will be collected on the day of service,
prior to seeing the provider. PLEASE BE PREPARED TO PAY THEM. For your convenience, we accept Visa,
Mastercard, Discover and American Express.
IF YOU ARE UNDER THE AGE OF 18 YOU MUST BE ACCOMPANIED BY A PARENT OR
LEGAL GUARDIAN.
We do require 24 hours notice for any cancellations or rescheduling of your
appointment. Failure to do so will result in a $25 missed appointment fee.
Please feel free to call us with any questions at 517-886-0333. Thank you
and we look forward to seeing you!
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