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YOUR OFFICE VISIT

Arrival
Please plan to arrive 15 minutes before your appointment to fill out the appropriate paperwork.

Co-Pays
(Please remember that your health insurance is a contract between you, your employer and your insurance carrier)
  • Co-pays are due at the time of your visit and are collected when you check in. If you can not pay your co-pay we will ask that you reschedule the appointment.
  • Please contact your insurance company if you are unsure of your benefits.

Financial responsibility
If there is a question of financial responsibility, the parent or legal guardian that accompanies a minor to see a provider will be responsible for the account.

First visit forms
To expedite your check in time on the first visit, feel free to print the following forms, fill out completely and bring them with you to the office for your first appointment. We will also need to see any insurance card you have coverage under.

 Patient Information Form
* In order to view PDF documents, you must have Adobe Acrobat Reader installed on your computer. If you do not have Adobe Acrobat Reader, you can download it by clicking this link.
 Patient Medical History Form
 Patient Acknowledgement Form

Insurance
(Please remember that your health insurance is a contract between you, your employer and your insurance carrier)
Your insurance card is needed prior to being seen. If you can not provide us with your insurance information you will be asked to reschedule the appointment or pay for the visit on the day of service.

Missed appointments
  • Please call the office 502.583.7546 if you know you are going to miss an appointment. This would allow another patient to be seen in your place.
  • If you are scheduled for surgery, a procedure or Accutane follow-up and you cancel or no show, we may not be able to reschedule another appointment in a timely manner. If you are on Accutane, you may run out of medication before we can get another appointment scheduled for you.
  • To cancel an appointment please call 24 hours beforehand and if you have a surgery or procedure scheduled please call 48 hours in advance.

Payment
  • Our practice accepts cash, personal check, Visa, Master Card and money orders.
  • Some elective procedures may require partial or full prepayment before they can be scheduled and those appointments will be cancelled if arrangements are not met.
  • Some diagnoses might be considered cosmetic and not covered by your insurance company. We will take payment on the date of service. If you have any questions regarding your coverage, please contact your insurance company.

Referrals
Any patient who comes in for an appointment without their referral (if their insurance company requires one) will have to pay for that days visit or reschedule at a later date.

Underage patients
Children and young adults under 18 will need to be accompanied by a parent or legal guardian. Our providers are not able to see small children without a parent or legal guardian present. Once the initial visit has been completed, young adults of driving age can be seen without parent or legal guardian for routine checkups.

Uninsured patients
We will accept payment for services rendered on the day of service.

Workers Compensation
Patients must bring written authorization with their claim number, company name and mailing address plus the adjusters name, mailing address and telephone number.


  Site maintainted by design made simple 501 South Second Street . Louisville, Kentucky 40202 . 502.583.7546 . Fax 502.589.3429