Download Forms

All new patients need to complete new patient paperwork. For your convenience, the forms are available for download. Print, complete and bring the forms to your appointment ! Get Adobe® Acrobat®.

PDFPersonal Information
Download PDF 721k

PDFConsent for Treatment
Download PDF 834k

PDFMedical History
Download PDF 859k

Health Plans

If you are a member of a health maintenance organization (HMO) or preferred provider organization (PPO), please contact your health plan before scheduling an appointment with Advanced Dermatology & Cosmetic Surgery to determine your plan's participation with us and the terms of your contract.

Claims

We will file your primary insurance claim upon verification of name, address and policy number with the health insurance company.

The EOB (Explanation of Benefits) from the insurance company will list services billed, amount paid and to whom payment was made.

Payments

If an insurance payment is mailed to Advanced Dermatology & Cosmetic Surgery, it will be reflected on your next monthly statement. If an insurance payment is erroneously sent to you, please endorse it to Advanced Dermatology & Cosmetic Surgery and mail to the following address:

Advanced Dermatology & Cosmetic Surgery
C/O: Insurance Payments
P.O. Box 862823
Orlando, FL 32886-2823

Advanced Dermatology & Cosmetic Surgery has contracts with the managed care plans listed below. Check with our Scheduling Department and your provider manual to assure that the physician or healthcare professional participates in your insurance plan.

Supported Providers

Most plans are accepted; if you don't see your plan listed, please call us at the following number: 1-866-400-DERM.

  • Aetna - HMO, PPO, POS, EPO, QPOS, Managed Choice, HMO Medicare
  • All Florida - PPO
  • American Heritage Life - PPO
  • American Medical Healthcare - HMO
  • American Medical Security - PPO, Plus
  • Amerigroup - Medicaid, Healthy Kids
  • AvMed - HMO, Medicare
  • BayCare Health Network - PPO
  • BCE Emergis - PPO
  • Beacon - Commercial, Medicaid, Medicare
  • BeechStreet/Capp Care - PPO
  • Blue Cross/Blue Shield - PPC, PPS, Advantage 65, DNS, Medicare and More, Health Options, Net Blue CCN - PPO
  • CHAMPUS/TRICARE
  • Choice Care Network - PPO, EPO, POS
  • CIGNA - PPO, Select, HMO, RPPO, POS
  • Citrus Healthcare - Commercial, Medicaid, Medicare
  • CMS - Florida Kid Care
  • Evolutions Network - PPO
  • First Health Network - PPO
  • Florida Hospital Healthcare Systems (FHHS)
  • Foundation - PPO, POS, HMO, Medicare HMO
  • Great West/One Health - POS, PPO, HMO
  • Healthease Medicaid
  • Health Network One - HMO, POS, ASO, Medicare, Medicaid, HealthyKids
  • HIP - HMO, PPO
  • Horizon/Multiplan - PPO
  • Humana - HMO, PPO, Medicare, POS, ASO, Gold Plus, Medicaid
  • Humana Military Healthcare - Champus
  • Medicaid
  • Medicare Part B
  • Multiplan - PPO
  • National Provider Network - PPO
  • One Health/ Great West - POS, PPO, HMO
  • One Source Health Network
  • Physicians Healthcare Plans - HMO, Medicare, Medicaid HMO, Healthy Kids
  • Plaines/Accountable - PPO, PPO Plus, PPO Gold
  • PPO Next / Preferred Health Providers/ Healthstar - PPO
  • Private Healthcare Systems (PHCS) - PPO
  • Providers Plus / Managed Care of America - PPO
  • Railroad Medicare
  • SouthCare - HMO, PPO
  • TRICARE/ CHAMPUS
  • United Healthcare - HMO, POS, PPO, Medicare
  • Volusia Health Network - PPO, EPO
  • Well Care/Staywell - HMO, POS, ASO, Medicare, Medicaid, HealthyKids

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