Patient Hub - MacInnis Dermatology

Patient Information and Forms

Patient Portal

Your one stop shop for your patient information and updates. Use the patient portal to request an appointment, prescriptions and prescription renewals. Contact our front desk staff to get access to your Patient Portal.

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Prescription Refills and Lab Requests

Please use the “Message Us” button to communicate with the staff members to request a prescription refill or lab results. You may also request a refill by contacting the office via phone or the patient portal. However, using the “Message Us” button will provide a quicker response time. Please do not send an e-mail request.

Patient Forms

Click on any form below and you will be able to print and complete the form prior to your appointment.

Medical Records Release Form

Patient Intake Form

Patient Consent Form

Minor Consent Form

New Patient Registration Form

Established Patient Form

HIPPA Privacy Form

Surgery Pre-Op Instructions

Surgery Post-Op Instructions

Biopsy Post-Op Care

Blu-Light Pre-Therapy

Blu-Light Post-Therapy

Insurance We Accept

Patient Rights and Protections Against Surprise Medical Bills If you have private health insurance, there are protections in place that provide visibility to your planned medical charges and fees when requested. If you’re uninsured or you decide not to use your health insurance healthcare services, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. Patients who are uninsured or who choose not to utilize insurance coverage for medical services have the right to request a good faith estimate for the total expected costs prior to receiving care. For cash-pay patients, a breakdown of costs for any tests or procedures beyond the overall medical visit charge are shared at the time of the visit. You can request a paper copy of this estimate from our office at any time. We will also keep a copy on file in your patient chart for future reference if need be. If the bill you receive is at least $400 more than your good faith estimate, you can dispute the charges. You have 120 days from the date on your bill to do so. For questions or more information about your rights under the ‘No Surprises Act’, visit www.cms.gov/nosurprises.

Currently we do not participate with the Medicaid insurance. Sorry for the inconvenience. We are more than happy to see any patients that do not have insurance coverage. If your insurance is not listed below, please contact our office.

AARP

AETNA

AMVED

BCBS

Champ/VA

CIGNA

GHI

Golden Rule

Humana

Medica

Medical Mutual

Medicare