Patient Forms & Insurance - Texas Dermatology Associates, P.A.

Currently Accepted Insurance

Aetna PPO, POS
Blue Cross Blue Shield PPO, POS
Cigna HMO/POS/PPO/PPA/EPO
Choice Care Network, Humana PPO
First Health PPO
Galaxy Health Network, PPO
Great West
Health Smart
Medical Control PPO Next
Medicare
Multi-Plan
North Texas Healthcare Network PPO, EPOS
PacifiCare PPO
PHCS PPO
Texas True Choice
UniCare Classic
United Healthcare EPOS, HMO, PPO, POS,

Patient Forms
All forms will need to be signed at the patients initial visit. Linked forms are Fillable and can be printed, then signed and brought to your first appointment.

Patient Registration Form

Patient Medical History Form

Notice of Protected Health Information &
Acknowledgement of Receipt of Notice

General Consent for Texas Dermatology Patients

Aesthetic/Cosmetic Interest Questionairre

In order to fill out and print these forms, you'll need Adobe® Acrobat Reader (version 5.0 or later). You may download the program for free by clicking here, which will give you the download information for it in a new browser window.