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Patient Forms

PRINT OUT: Scroll down to the “Printable Forms” section, print the form, fill out and either fax or bring into our office on the day of your visit.

Printable Forms

To download the forms and information you need, simply click the links below. For added convenience, our forms can be downloaded and saved for future use.

> New Patient Form/ Update Information Form/Billing form/Insurance information

> Authorization For Release Of Protected Health Information

>Medicare opt out form

You can print and complete these patient forms in advance. This will allow us to process your intake information quickly and allow you to be seen sooner in the office. Or you can complete the copy provided by one of our Patient Service Representatives at check-in.

Billing & Insurance

As a courtesy, we bill most private insurances.

Miller Dermatology is preferred providers with most major insurances. Including;

Blue Cross Blue Shield
Aetna
EBMS
Meritain
And other insurances that go through the Multiplan.

Miller Dermatology is not preferred providers with Medicaid, Tricare, VA, and Campus. We do see some Medicare patients that are referred by their primary providers, or are already patients in our clinic. We plan to see all Medicare patients by November 2024.

We do our best to bill to all private insurance companies.

If you have questions on if we are in network with your insurance company, you may contact us at (907) 276-1315 or your insurance company.

We accept Visa and Mastercard.