Patient Forms & Policies
Your first visit to Mitchell Dermatology involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You’ll find all the practical information you need!
We welcome you to fill out these forms so we can expedite your first visit:
- PERMISSION TO RELEASE INFORMATION
- PERMISSION TO RELEASE INFORMATION (pdf version)
- PATIENT INFORMATION AND HIPAA AUTHORIZATION
We encourage you to register for our online patient portal SADIO. This portal will allow access to online scheduling, messaging, appointment reminders, laboratory review and more.
Once you have scheduled your appointment, you will receive an email link from our Patient Portal, firstname.lastname@example.org asking for verification of your email address. Once you verify your address, you will need to set up your patient portal and complete your medical information, financial policy and HIPAA acknowledgment and consent forms prior to your appointment.
We gladly accept the following: Cash, Check, MasterCard, Visa, American Express, Discover, Debit Cards, Aspire, Brilliant Distinctions and Care Credit.
CareCredit helps you pay for out-of-pocket healthcare expenses for you and your family! Once you are approved, you can use it to help manage health, wellness, and personal care costs not covered by insurance.
Click Here for everything you need to know about the CareCredit healthcare credit card before you apply.
To schedule an appointment, please call us at 419.871.3737. A credit card on file is required to hold all appointments. If, for any reason you cannot keep a scheduled appointment, or will be delayed, please call us as soon as possible.
We respectfully request a 24-hour notice of all cancellations. Failure to cancel with a 24-hour+ notice or a missed appointment will be recorded and an administrative fee of $50 will be charged to your credit card on file.
A credit card on file is required for all scheduled appointments. The card will only be charged in cases in which Mitchell Dermatology is not given a 24-hour notice of cancellation or if you do not show up for your appointment.
We require a deposit of $50 when scheduling an aesthetic or a cosmetic treatment.
We require a deposit of $75 for aesthetic consultations with our aesthetician and aesthetic nurses.
We require a deposit of $150 for cosmetic consultations with Dr. Mitchell.
All deposits may be applied towards aesthetic and cosmetic services.
Payment for office visits and services such as biopsies, excisions, and cosmetic services are expected at the time of the appointment. Many insurance plans require co-payments, co-insurances and/or deductibles. We will collect these payments at your appointment.
We accept most insurance plans. Please have your insurance card available when you make your appointment. This will help us confirm if we accept (are contracted with) your insurance carrier and verify your benefits.
We currently accept assignment from Medicare and participate with most preferred provider insurance plans. Please check with your insurance company to find out if our office participates with your plan or call our billing department for further guidance. The patient is responsible for any deductible and co-insurance balance.
Frequently, health insurance companies may pay only part of the physician’s fee and services. The extent of your benefits is determined by your individual policy. Please keep in mind that services have been rendered to you, the patient, not the insurance company, and you are ultimately responsible for any outstanding balance on your account. We allow thirty (30) days for submission and processing of insurance claims.
We will gladly assist you with questions regarding claims with your insurance company. An account balance outstanding more than thirty (30) days is considered delinquent and at this point, your account may be turned over to collections.
FREQUENTLY ASKED QUESTIONS
- Anthem HMO
- Medical Mutual
- United Healthcare
*We apologize we do not accept Medicaid, Paramount Advantage & Buckeye Health Plan.
We accept Cash, Check, MasterCard, Visa, American Express, Discover, Debit Cards, Care Credit, Brilliant Distinctions and Allē.
Cosmetic procedures are considered elective and are not covered by your insurance company because they are considered not medically necessary. Examples of such procedures are Botox, chemical peels, microdermabrasion, Restylane, skin tag removals and removal of benign moles.
It is a comprehensive exam where the dermatologist or physician assistant provider will ask you about both your family and personal skin history—whether anyone has had skin cancer, how often you’re exposed to the sun, how many sunburns you’ve had, and of course, whether you’ve ever done any indoor tanning.
The dermatologist or physician assistant provider will exam every inch of your skin from your scalp to between your toes. If you’re feeling self-conscious, remember that they’ve seen it all before and a few minutes of exposure means knowing the truth about your skin. This is a great time for you to get familiar with your skin also. If you need anything removed, that may happen at a later appointment.
View your skin exam findings HERE
You should see a dermatologist yearly for a full body skin exam. It is the best way to spot cancers early. Skin cancers may be curable when caught early.