Patient Resources

Patient Forms & Information

PATIENT FORMS

Use the links below to access a pdf version of the patient forms. The pdf will open in a new tab from where you can print or save it by clicking on the appropriate icon.


RELEASE OF PATIENT INFORMATION

CONSENT FOR THE RELEASE OF PATIENT INFORMATION

Medical records can take as long as 2 weeks to complete.


-SURGICAL CARE AND INFORMATION

Below is for both Excision & MOHS procedures.

LASER AND SKIN WOUND CARE INFORMATION

EXCISIONAL SURGERY PREOPERATIVE INSTRUCTIONS

BIOPSY CARE

MOHS BROCHURE


-NEW PATIENT FORMS

NEW PATIENT MEDICAL HISTORY

NEW PATIENT INFORMATION

NEW PATIENT HIPPA


-AUTHORIZATION TO TREAT A MINOR

AUTHORIZATION FOR CONSENT TO TREAT A MINOR


-RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Good Faith Estimate


Please download the forms and either take a photo of them or just email them to the office. If unable to email please mail them to the main office

Use the links above to access a pdf version of the patient form. The pdf will open in a new tab from where you can print or save it by moving your mouse cursor to the bottom right of your screen and clicking on the appropriate icon.

Insurance & Payment

We are a participating provider with many insurance companies and will gladly submit your claims for you.

We ask that you pay any deductible, co-insurance, or copay at the time the service is provided.

For your convenience, we accept MasterCard, Visa, Discover, American Express, cash and checks.

Prescription Refills

Please allow 48 hours for all prescription refills. When requesting a refill on your prescription, please have your medication information and the pharmacy phone number available for the office assistant. A review of your medical record by the physician will be required before refills are approved and occasionally it may be necessary for you to return to the office for a re-evaluation of your condition.

Indications For Skin Surgery

 

Dermatologists cite three reasons for performing skin surgery:

1. To prevent or provide early control of the disease.
2. To improve the skin’s appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease.
3. To establish a definite diagnosis.

A change in a nevus (mole) or an unexplained growth can indicate a serious problem. A dermatologist should be seen if a nevus or skin lesion becomes larger, changes color or develops an irregular border.

Large nevi that are present at birth have a higher rate of cancerous change, which may necessitate excision. Extensive and potentially disfiguring surgery can often be averted by prompt surgical removal, by specialized freezing, or by treatment with chemicals applied to the diseased tissue.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

Improving The Skin's Appearance

Many blemishes that occur on the skin, such as age or brown spots, birthmarks, nevi (moles), warts, wrinkles, and scars, can be eliminated or at least improved by an appropriate dermatological surgical procedure.

Age or brown spots are large freckles that develop on the face, back, and chest, as well as on sun-exposed areas. They can be minimized by using sunscreen and respond well to treatment with chemical peeling, cryosurgery, or laser surgery.

Birthmarks are areas of red-brown color that come in all sizes and shapes and can occur all over the body. Most are flush with the skin’s surface, but a few are raised. Port wine stains are deep wine-colored, and the VPL or pulsed dye laser is the preferred form of treatment if they are treated. Strawberry vascular birthmarks will often increase in size in the early months of life but usually spontaneously disappear by the age of six or so. Oral medicines can be used to diminish the strawberry birthmarks if they become disabling.

Nevi (moles) are common skin growths that are usually small and tan or brownish, are sometimes raised, and may occasionally change shape or color. Dermatologists remove nevi to improve appearance, to prevent the nevus from enlarging, or changing into cancer. Large nevi that are present at birth may have a higher rate of cancerous change. These nevi have a potential for early removal. One method of removal is surgical excision, which is done in stages over a period of several months.

Warts are caused by viruses and consist of piled-up layers of skin. They may develop at any location on the skin and may occur in people of all ages. Although topical medication, either over-the-counter or prescription, may cause the resolution of warts, some warts are resistant and require prescription medication, cryosurgery, curettage, electrosurgery, injection with chemicals, or perhaps laser therapy.

Scars resulting from acne, chickenpox, accidents, or previous surgery may be improved by laser resurfacing. With dermabrasion, the skin is frozen with a spray medication, after which a high-speed rotary abrasive wheel is used to remove the outer layers of skin and soften the irregular edges of the scar. Laser resurfacing consists of using an Erbium laser to vaporize areas of the scar. Some scars that are more depressed can be made to appear more natural using filling agents such as collagen or other types of synthetic preparations. Raised scars can be surgically leveled or flattened with steroid injections. Any operation results in some scar formation; however, a dermatologic surgeon places incisions so that the resulting scar will be minimal.

Wrinkles and deep expression lines can be partially erased with dermabrasion and laser resurfacing although the benefit does not last indefinitely. Topical chemical peeling with dilute acids can be used to minimize sun-induced wrinkles and yellowing, resulting in a more youthful appearance.

Actinic keratoses are thick, warty, rough, reddish growths that appear on the sun-exposed areas of the body. They sometimes develop into squamous cell cancer and are usually treated with cryosurgery.

Seborrheic keratosis is raised, has tan or brown growths, and is removed in a manner similar to actinic keratosis. They often become itchy and irritated by clothing. They do not turn into skin cancers.

Cysts are small closed sacs that contain fluid or solid material. Infection often necessitates that the dermatologist drains the contents. Surgical excision is the preferred method for the complete removal of the cyst.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

In The Dermatologist’s Office – What To Expect

During the patient’s office visit, the dermatologist will discuss the person’s medical history, examine and diagnose the skin problem, explain what could happen if it is not treated, and then describe treatment options and follow-up care.

In most cases, the dermatologist will select and carry out the appropriate treatment procedure at that time. However, if the examination indicated a likelihood of cancer, the dermatologist may take a biopsy and schedule the patient for surgery at a later date.

Typically, consultations are required before cosmetic surgical procedures are performed. During the consultation, the dermatologist will explain the procedure to be done and how much discomfort, if any, will result, outline any postoperative restrictions, and answer any pertinent questions the patient may have.

The patient should always feel free to discuss any operative procedure and its cost with the physician.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

Access our patient education library to learn more about your condition, medications, and treatments: Patient Education Library

PATIENT FORMS

Use the links below to access a pdf version of the patient forms. The pdf will open in a new tab from where you can print or save it by clicking on the appropriate icon.


RELEASE OF PATIENT INFORMATION

CONSENT FOR THE RELEASE OF PATIENT INFORMATION

Medical records can take as long as 2 weeks to complete.


-SURGICAL CARE AND INFORMATION

Below is for both Excision & MOHS procedures.

LASER AND SKIN WOUND CARE INFORMATION

EXCISIONAL SURGERY PREOPERATIVE INSTRUCTIONS

BIOPSY CARE

MOHS BROCHURE


-NEW PATIENT FORMS

NEW PATIENT MEDICAL HISTORY

NEW PATIENT INFORMATION

NEW PATIENT HIPPA


-AUTHORIZATION TO TREAT A MINOR

AUTHORIZATION FOR CONSENT TO TREAT A MINOR


-RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Good Faith Estimate


Please download the forms and either take a photo of them or just email them to the office. If unable to email please mail them to the main office

Use the links above to access a pdf version of the patient form. The pdf will open in a new tab from where you can print or save it by moving your mouse cursor to the bottom right of your screen and clicking on the appropriate icon.

INSURANCE AND PAYMENT

We are a participating provider with many insurance companies and will gladly submit your claims for you.

We ask that you pay any deductible, co-insurance, or copay at the time the service is provided.

For your convenience, we accept MasterCard, Visa, Discover, American Express, cash and checks.

PRESCRIPTION REFILLS

Please allow 48 hours for all prescription refills. When requesting a refill on your prescription, please have your medication information and the pharmacy phone number available for the office assistant. A review of your medical record by the physician will be required before refills are approved and occasionally it may be necessary for you to return to the office for a re-evaluation of your condition.

INDICATIONS FOR SKIN SURGERY

Dermatologists cite three reasons for performing skin surgery:

1. To prevent or provide early control of the disease.
2. To improve the skin’s appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease.
3. To establish a definite diagnosis.

A change in a nevus (mole) or an unexplained growth can indicate a serious problem. A dermatologist should be seen if a nevus or skin lesion becomes larger, changes color or develops an irregular border.

Large nevi that are present at birth have a higher rate of cancerous change, which may necessitate excision. Extensive and potentially disfiguring surgery can often be averted by prompt surgical removal, by specialized freezing, or by treatment with chemicals applied to the diseased tissue.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

IMPROVING THE SKIN’S APPEARANCE

Many blemishes that occur on the skin, such as age or brown spots, birthmarks, nevi (moles), warts, wrinkles, and scars, can be eliminated or at least improved by an appropriate dermatological surgical procedure.

Age or brown spots are large freckles that develop on the face, back, and chest, as well as on sun-exposed areas. They can be minimized by using sunscreen and respond well to treatment with chemical peeling, cryosurgery, or laser surgery.

Birthmarks are areas of red-brown color that come in all sizes and shapes and can occur all over the body. Most are flush with the skin’s surface, but a few are raised. Port wine stains are deep wine-colored, and the VPL or pulsed dye laser is the preferred form of treatment if they are treated. Strawberry vascular birthmarks will often increase in size in the early months of life but usually spontaneously disappear by the age of six or so. Oral medicines can be used to diminish the strawberry birthmarks if they become disabling.

Nevi (moles) are common skin growths that are usually small and tan or brownish, are sometimes raised, and may occasionally change shape or color. Dermatologists remove nevi to improve appearance, to prevent the nevus from enlarging, or changing into cancer. Large nevi that are present at birth may have a higher rate of cancerous change. These nevi have a potential for early removal. One method of removal is surgical excision, which is done in stages over a period of several months.

Warts are caused by viruses and consist of piled-up layers of skin. They may develop at any location on the skin and may occur in people of all ages. Although topical medication, either over-the-counter or prescription, may cause the resolution of warts, some warts are resistant and require prescription medication, cryosurgery, curettage, electrosurgery, injection with chemicals, or perhaps laser therapy.

Scars resulting from acne, chickenpox, accidents, or previous surgery may be improved by laser resurfacing. With dermabrasion, the skin is frozen with a spray medication, after which a high-speed rotary abrasive wheel is used to remove the outer layers of skin and soften the irregular edges of the scar. Laser resurfacing consists of using an Erbium laser to vaporize areas of the scar. Some scars that are more depressed can be made to appear more natural using filling agents such as collagen or other types of synthetic preparations. Raised scars can be surgically leveled or flattened with steroid injections. Any operation results in some scar formation; however, a dermatologic surgeon places incisions so that the resulting scar will be minimal.

Wrinkles and deep expression lines can be partially erased with dermabrasion and laser resurfacing although the benefit does not last indefinitely. Topical chemical peeling with dilute acids can be used to minimize sun-induced wrinkles and yellowing, resulting in a more youthful appearance.

Actinic keratoses are thick, warty, rough, reddish growths that appear on the sun-exposed areas of the body. They sometimes develop into squamous cell cancer and are usually treated with cryosurgery.

Seborrheic keratosis is raised, has tan or brown growths, and is removed in a manner similar to actinic keratosis. They often become itchy and irritated by clothing. They do not turn into skin cancers.

Cysts are small closed sacs that contain fluid or solid material. Infection often necessitates that the dermatologist drains the contents. Surgical excision is the preferred method for the complete removal of the cyst.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

IN THE DERMATOLOGIST’S OFFICE – WHAT TO EXPECT

During the patient’s office visit, the dermatologist will discuss the person’s medical history, examine and diagnose the skin problem, explain what could happen if it is not treated, and then describe treatment options and follow-up care.

In most cases, the dermatologist will select and carry out the appropriate treatment procedure at that time. However, if the examination indicated a likelihood of cancer, the dermatologist may take a biopsy and schedule the patient for surgery at a later date.

Typically, consultations are required before cosmetic surgical procedures are performed. During the consultation, the dermatologist will explain the procedure to be done and how much discomfort, if any, will result, outline any postoperative restrictions, and answer any pertinent questions the patient may have.

The patient should always feel free to discuss any operative procedure and its cost with the physician.

© Copyright 1984, revised 1987, 1999 American Academy of Dermatology

PATIENT EDUCATION LIBRARY

Access our patient education library to learn more about your condition, medications, and treatments: Patient Education Library

Hilton Head Dermatology and Skin Cancer Center P.A. is always willing to assist our patients in meeting their financial obligations. We participate in many insurance networks. Several, but not all, are listed below.

If you have any questions, please contact our billing office for further information: 843.689.9200

Financial & Insurance

Tricare Prime requires prior authorization and must be obtained prior to your appointment. Any co-payments due will be collected at that time. Tricare Standard does not require prior authorization. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.

We are participating with BC/BS PPO plans. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.

We are a participating provider with many, but not all, of the CIGNA Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.

We are a participating provider with many, but not all of the AETNA Healthcare plans. Please contact our office to determine if your plan is eligible.

Several plans have signed agreements with Medicare to automatically accept Medicare claims. If your insurance does not automatically accept Medicare claims, we will gladly forward all claims to secondary insurance plans.

If you do not have any insurance, we ask that payment be made when services are rendered. If you must set up a payment plan, we ask that you meet with our accounting staff prior to your visit to determine if you qualify.

All cosmetic procedures are payable prior to services being rendered.

We accept Care Credit payment plans. Contact Care Credit® at www.CareCredit.com for information to determine your eligibility.

We are a participating provider with United Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.

We are a participating Medicare provider. You will be responsible for 20% of the Medicare allowable charge, as well as any deductible co-insurance and/or co-payment not yet met. We will collect the patient portion at the time of service.

We will accept Medicaid provided you have a referral/prior authorization approval from your primary care physician prior to your appointment.

Financial Policies

  • Your insurance policy is a contract between you and your insurance company so we cannot guarantee payment on claims.
  • Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge.
  • It is your responsibility to pay any deductible amount, co-insurance, and all other balances not paid by your insurance company. It is also your responsibility to advise the billing office of any required pre-authorization needed for your insurance.
  • It is customary to pay for all services when rendered. This office will file for insurance benefits on plans in which we participate. You are responsible to this office for all fees not paid within 45 days, regardless of insurance coverage, along with collection expenses and/or reasonable attorney fees, if applicable.

TRICARE

Tricare Prime requires prior authorization and must be obtained prior to your appointment. Any co-payments due will be collected at that time. Tricare Standard does not require prior authorization. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.

BLUE CROSS/BLUE SHIELD PPO

We are participating with BC/BS PPO plans. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.

CIGNA

We are a participating provider with many, but not all, of the CIGNA Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.

AETNA

We are a participating provider with many, but not all of the AETNA Healthcare plans. Please contact our office to determine if your plan is eligible.

MEDICARE SUPPLEMENTAL INSURANCE

Several plans have signed agreements with Medicare to automatically accept Medicare claims. If your insurance does not automatically accept Medicare claims, we will gladly forward all claims to secondary insurance plans.

SELF PAY / NO INSURANCE

If you do not have any insurance, we ask that payment be made when services are rendered. If you must set up a payment plan, we ask that you meet with our accounting staff prior to your visit to determine if you qualify.

COSMETIC PROCEDURE

All cosmetic procedures are payable prior to services being rendered.

CARE CREDIT

We accept Care Credit payment plans. Contact Care Credit® at www.CareCredit.com for information to determine your eligibility.

UNITED

We are a participating provider with United Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.

MEDICARE

We are a participating Medicare provider. You will be responsible for 20% of the Medicare allowable charge, as well as any deductible co-insurance and/or co-payment not yet met. We will collect the patient portion at the time of service.

MEDICAID

We will accept Medicaid provided you have a referral/prior authorization approval from your primary care physician prior to your appointment.

FINANCIAL POLICIES

  • Your insurance policy is a contract between you and your insurance company so we cannot guarantee payment on claims.
  • Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge.
  • It is your responsibility to pay any deductible amount, co-insurance, and all other balances not paid by your insurance company. It is also your responsibility to advise the billing office of any required pre-authorization needed for your insurance.
  • It is customary to pay for all services when rendered. This office will file for insurance benefits on plans in which we participate. You are responsible to this office for all fees not paid within 45 days, regardless of insurance coverage, along with collection expenses and/or reasonable attorney fees, if applicable.

FAQs About Facial Treatments

How do I choose the right facial treatment for my skin type?

We will perform a comprehensive skin type assessment and offer tailored recommendations through a skincare consultation. This ensures your facial treatment aligns perfectly with your unique skin needs and concerns.

Are there any facial treatments for anti-aging?

We offer specialized anti-aging facials designed to target fine lines, wrinkles, and other signs of aging. Our treatments focus on wrinkle reduction and age reversal, employing advanced techniques and premium products to promote youthful, revitalized skin.

What is the difference between a standard facial and a medical-grade facial?

Standard facials primarily focus on surface-level cleansing and relaxation. In contrast, medical-grade facial treatments delve deeper, utilizing advanced skincare technologies and potent formulations to address specific skin issues effectively. These medical-grade treatments offer more profound and long-lasting results.

Are facial treatments suitable for sensitive skin?

Certainly! Our practice provides dermatologist facials in Hilton Head Island specifically curated for sensitive skin. These treatments incorporate mild, soothing ingredients and techniques to cater to skin sensitivity, ensuring a comfortable and beneficial experience.

How long does a facial treatment take and what is the cost?

Treatment duration varies based on the type of facial and individual requirements. Typically, facial sessions range from 30 to 90 minutes. Costs depend on the chosen service and personalized treatment plan. Our team will provide transparent pricing details during your consultation.

What should I expect during my first facial treatment session?

During your initial facial experience, expect a warm welcome from our skincare experts. You’ll undergo a detailed consultation where we’ll discuss your skincare goals and concerns. Then, relax and enjoy a personalized facial catered to your skin’s needs, providing a rejuvenating and pampering experience.

FAQs About Cosmetic Services

How Do Cosmetic Treatments Improve Skin Appearance?

Cosmetic treatments enhance skin appearance by targeting various concerns, including wrinkles, fine lines, pigmentation, and texture. Techniques like laser therapy, chemical peels, and microdermabrasion remove the outer layers of skin, promoting new, healthier skin growth.

Are Cosmetic Procedures Safe?

Yes, when performed by a qualified professional. Safety measures and standards are in place to minimize risks. However, individual consultation is essential to assess personal health and suitability.

Who Is a Good Candidate for Cosmetic Services?

Ideal candidates are individuals in good health with realistic expectations and specific cosmetic concerns they wish to address. We understand that each person has unique concerns, and that’s why we offer a thorough consultation to ensure that our treatments align with your individual needs and expectations.

What Should I Expect During a Cosmetic Consultation?

Expect a discussion about your skin concerns, medical history, and goals. Our skincare experts will assess your condition and recommend suitable treatments, discussing potential outcomes and care plans.

How Long Do Cosmetic Results Last?

The duration varies by treatment and individual factors. Some treatments offer temporary results, while others provide longer-lasting changes. Maintenance sessions may be necessary.

How Much Do Cosmetic Services Cost?

Costs vary widely depending on the type of treatment, the expertise of the practitioner, and the geographical location. Our team will ensure transparent pricing details are provided during your consultation.

Are There Any Side Effects or Risks?

Possible side effects include temporary redness, swelling, and discomfort. Risks depend on the procedure’s nature and are generally low when done by experienced professionals.

Can Cosmetic Services Address Specific Skin Concerns?

Yes, treatments are available for wrinkles, acne scars, pigmentation, and more. Options are tailored to address specific concerns effectively.

How Do I Choose the Right Cosmetic Treatment for My Needs?

Consider your goals, research available treatments, and consult with a professional to identify the best option for your needs and skin type.

What Is the Best Age to Start Cosmetic Treatments?

There’s no universal age; it depends on individual concerns and goals. We invite you to sit down with one of our experts, who can guide you through the options and help pinpoint the perfect moment for you to begin your treatments.

FAQs About Skin Cancer Treatments

What are the primary types of skin cancers?

The common skin cancers include Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

How does Hilton Head Dermatology address skin cancer cases?

We offer diverse surgical dermatology treatments, such as Excisional Surgery, Laser Surgery, Cryosurgery, and Mohs Micrographic Surgery, tailored to each patient’s specific diagnosis.

What distinguishes Mohs Micrographic Skin Cancer Surgery from other methods?

Mohs surgery is employed for complex skin cancers, providing a higher likelihood of cure while preserving normal tissue through comprehensive microscopic examination of removed tissue.

Do you offer cosmetic/plastic surgery for post-cancer repair and scar revisions?

Yes, we meticulously plan and execute reparative cosmetic surgery techniques after successful cancer removal, with a focus on recreating a more natural appearance.

What types of skin growth removal procedures are available at your center?

We can remove nevi (moles), warts, age spots, cysts, and various other lesions using a range of methods.

Where can I find detailed information on each surgical procedure’s suitability for my condition?

You can explore comprehensive details on our website or consult our dermatologists for personalized guidance.

How does insurance coverage work for skin cancer surgery, and what are the available payment options?

Our staff can assist you in understanding insurance coverage and explore payment options to make your treatment accessible.

What is the typical recovery process after skin cancer surgery?

Recovery times may vary depending on the surgical method. Detailed post-operative care instructions will be provided by our medical team.

Are there potential risks or complications associated with skin cancer surgery?

Although these procedures are generally safe, it’s important to discuss potential risks and complications with your dermatologist during the consultation.

How can I schedule an appointment for skin cancer diagnosis and treatment at Hilton Head Dermatology?

You can easily book a consultation appointment for our plastic surgery procedures through our website or by reaching out to our clinic directly. Talk to us today!