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Patient Information

Office Policies

Cancellation / No-Show Policy
Cancellation / No-Show Policy

We understand that there are times when you must miss an appointment due to emergencies or other obligations. However, due to the high patient demand and limited availability of appointments, we have instituted a cancellation fee.

If an appointment is not cancelled at least 24 hours in advance, you will be charged a twenty-five-dollar ($25) fee that is NOT covered by insurance. (Effective 3/1/2018)

Insurance & Payment Information

It is the patient’s responsibility to find out if Empire Dermatology participates with your insurance company. Each insurance company has many plans that can vary even within one employer. We have a list of participating insurance carriers on our website at empirederm.com. Whatever is not covered by your insurance plan (s) is your responsibility. You must present your insurance card (s) at each visit. Your co-pay is due at the time of services. We accept Cash, Checks, Master Card, Visa and American Express. We understand that unexpected situations can come up and we want to do what we can to help our patients. When our patients refuse to work with us and refuse to pay their bills, we will need to discontinue services. Please confirm your address, phone and insurance are up to date. An estimated amount for services billed is available upon request. There is a $30 fee for returned checks.

Privacy Practice Policy

HIPAA Policy

Download Form

Request of Record Release

New Patient Forms

Patient Intake Form

Notice of Privacy Practice Agreement