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.

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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

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Patient Intake Form

Medical Release Form

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Minor Consent Form

Medical Release Form

New Patient Registration Form

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New Patient Registration Form

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Established Patient Form

New Patient Registration Form

Established Patient Form

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HIPPA Privacy Practices

New Patient Registration Form

Established Patient Form

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Surgery Pre-op Instructions

Surgery Post-Op Care Instruction

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Surgery Post-Op Care Instruction

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Blue Light Pre-Therapy

Surgery Post-Op Care Instruction

Blue Light Pre-Therapy

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Blue Light Post-Therapy

Blue Light Pre-Therapy

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Biopsy Post-Op Care

Blue Light Post-Therapy

Biopsy Post-Op Care

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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

MacInnis Dermatology

WE Love your spots!

Patient Information and Forms

Patient Portal

Arriving for your appointment

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

Prescription Refills and Lab Requests

Patient Resources