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.
Arriving for your appointment
Please be sure to bring your insurance card(s) and a valid picture ID that has your current mailing address with you to your first visit. If you forget to bring these items you will be asked to reschedule.
Below are our information forms. Please fill out all pertinent forms prior to coming in for your visit to MacInnis Dermatology.
Patient Forms
Medical Release Form
Medical Release Form
Medical Release Form
Patient Intake Form
Medical Release Form
Medical Release Form
Minor Consent Form
Medical Release Form
New Patient Registration Form
New Patient Registration Form
New Patient Registration Form
New Patient Registration Form
Established Patient Form
New Patient Registration Form
Established Patient Form
HIPPA Privacy Practices
New Patient Registration Form
Established Patient Form
Surgery Pre-op Instructions
Surgery Post-Op Care Instruction
Surgery Post-Op Care Instruction
Surgery Post-Op Care Instruction
Surgery Post-Op Care Instruction
Surgery Post-Op Care Instruction
Blue Light Pre-Therapy
Surgery Post-Op Care Instruction
Blue Light Pre-Therapy
Blue Light Post-Therapy
Blue Light Post-Therapy
Blue Light Pre-Therapy
Biopsy Post-Op Care
Blue Light Post-Therapy
Biopsy Post-Op Care
Insurance We Accept
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
- Avmed
- BCBS
- ChampVA
- Cigna
- GHI
- Golden Rule
- Humana
- Medica
- Medical Mutual
- Medicare
- Railroad Medicare
- Secure Horizons
- Tricare
- UMR
- United Health Care
Prescription Refills and Lab Requests
Please log into the patient portal to request a prescription refill or communicate a message to one of the staff members. You may contact the office via phone to request refills, however the patient portal will provide a quicker response time. Do not send an e-mail request
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