Patient Resources
Office policies
Please review our office policies before your visit. You will be asked to sign an acknowledgment of these policies, our privacy practices and HIPAA authorization.
At a glance
- Bring
- A valid state ID and your insurance card. A parent or legal guardian’s ID for patients under 18.
- Cancel early
- Cancel or reschedule at least 24 hours before your appointment.
- Missed visit fee
- $75 for office visits. $150 for surgery, filler and aesthetician appointments.
- Cosmetic purchases
- Paid in full at the time of service. All sales are final.
Unfamiliar word? See our glossary of skin care terms.
This is the text of our Office Policies, Privacy Practices and HIPAA form (revised July 30, 2026). Download the form to sign
Identification
We obtain a copy of a valid state ID and insurance card from each patient for verification purposes. If the patient is a minor, a parent or legal guardian’s ID will be obtained.
Patients under 18: if someone other than a parent or legal guardian is bringing the patient, please contact our office before the appointment. If authorization is not received within 15 minutes of the scheduled appointment time, the appointment may be rescheduled. If applicable, please provide a copy of conservatorship or guardianship papers before the appointment.
Insurance
Charges will be filed at the patient’s request. Copays, coinsurance and any unmet deductible are due at the time of service. If you have questions about your coverage, it is your responsibility to contact your insurance company before your appointment. You are financially responsible for any charges not covered by your insurance. We collect at the time of service based on the information we obtain from your insurance company.
Lab and pathology
Labs will be billed separately by Quest Diagnostics or LabCorp. Pathology will be billed by Prime Medical Group. It may be necessary to send your pathology specimen to an outside lab, and a separate bill will be sent to you.
Referrals
If your insurance provider requires a referral, it is ultimately the patient’s responsibility to obtain it from their primary care physician. Please call ahead to make sure we have your referral, to avoid delays or having to reschedule your appointment.
Uninsured patients
Payment in full is expected at the time of service. A Good Faith Estimate will be sent to you before your appointment.
Non-covered charges
All charges not payable by your insurance company are the patient’s responsibility and are due at the time of service.
Cosmetic procedures, services and products
Cosmetic procedures, services and products cannot be filed with your health insurance and are payable in full when services are provided. All sales are final, non-transferable to another person, and not eligible for trade or exchange. Pre-purchased products and services expire one year from the date of purchase unless otherwise noted.
Returned checks
There is a $30.00 charge for all returned checks.
Late cancellation and missed appointment policy
We value your time and the time of our providers. The following policy applies:
- 24-hour notice required: appointments must be canceled or rescheduled at least 24 hours before the scheduled appointment time.
- Missed appointment fees: if you miss your appointment or do not give 24 hours’ notice, a non-refundable fee will be charged to your account: $75 for standard office visits and $150 for surgical procedures, filler appointments and aesthetician appointments. These fees are not covered by insurance and are the patient’s responsibility.
- Late arrival: patients who arrive after their scheduled appointment time may be asked to reschedule. If the appointment is rescheduled because of a late arrival, the missed appointment fee will apply.
- Credit card on file: after the first missed or late-canceled appointment, a valid credit card must be kept on file to schedule future appointments. The card on file will be charged automatically the morning after any missed or late-canceled appointment.
- Discharge from the practice: after multiple missed or late-canceled appointments within a 12-month period, a patient may be formally discharged from the practice.
AI software assistance
As part of our commitment to high-quality and efficient care, our practice may use secure artificial intelligence (AI) software to help document your medical visit. These tools are used under the supervision of your health care provider and are designed to ensure accurate and timely medical records. Your information remains confidential and protected under HIPAA regulations.
Credit cards on file
We offer the option to securely store your credit card in your electronic medical record. Only the last four digits are visible to us. The card on file can be used to pay balances you are responsible for after insurance claims are settled, and to pay cosmetic charges. Appointments that require a card on file include virtual telehealth, hair loss, self-pay and cosmetic appointments, and any appointment being rescheduled after a missed or late-canceled visit.
Changes to your health insurance or health
You agree to notify the clinic of any changes to your health insurance or health status.
Notice of Privacy Practices — acknowledgment of receipt
By signing the form, you acknowledge that you have been given the opportunity to review and obtain a written copy of the Pinnacle Dermatology / Prime Medical Group Notice of Privacy Practices. The notice describes how your health information may be used or disclosed. It may change, and you may get a revised copy at any time.
Release of information to family and friends
You have the right to name family members, friends or others who may receive medical or payment information about you. Under HIPAA requirements, we are not allowed to give this information to anyone without your consent. The form includes a section for this.