forms

If you are a new patient to Epiphany Dermatology, please print out and complete the New Patient Forms below to expedite your visit.

Please BE SURE to also bring your DRIVER’s LICENSE and INSURANCE CARD with you as well. This information is required at the time of your visit so that we are able to verify your insurance benefits. All benefit information received from your insurance company is only a quote of benefits. Patients are responsible for any services that are not covered by their insurance policy.

Epiphany Patient Registration Forms

 

Forms of Payment:
We accept Visa, MasterCard, Discover, CareCredit, Checks, Cash and CareCredit.