“Only the best care for you and your skin”

Se Habla Español

part-of-the-logo Integrated Dermatology of Calumet City, LLC Square

Take a moment to complete the paperwork in the comfort of your own home. Instead of trying to remember everything that needs to be marked down with a ballpoint pen on a wooden clipboard, you can save on both time and stress by completing your registration forms beforehand.

 

Square

We look forward to seeing you soon! Call us today at (708) 862-1290 (IL) or 219-865-8800 (IN).

-  Driver’s license or a valid picture ID

-  Insurance information

-  Co-Payments are due at the time of each visit

-  List of current medications

-  Completed registration form

Save time by coming prepared

-  Free consultations

-  Evening and Saturday appointments

-  Personal service

-  Individual attention

Experience the Integrated Dermatology of Calumet City, LLC difference

We are dermatologists who tend to any medical condition - regardless of your skin type!

Patients first

Take time now, save time later

Forms

CONSENT FORM FOR TREATMENT OF A MINOR HEALTH HISTORY REGISTRATION FORM SOCIAL HISTORY

Requesting an appointment is as simple and convenient as clicking here.

Your appointment time is reserved especially for you.  All Integrated Dermatology of Calumet City, LLC patients must give 24 hours notice for cancellations.  There will be a $35 “non-cancelled appointment” fee assessed to your account, if timely notice is not made.

Appointments

If we are contracted with your insurance, we will bill your insurance for your charges.  It is our payment policy to collect the appropriate payment due from the patient at the time the service is rendered. This may only be your co-payment, deductible and/or co-insurance, but we do ask for payment at the time of your visit.  

If we are not contracted with your insurance, we can still see you; however, payment is due in full at the time of service.  You will be given a receipt so that you can file with your insurance for reimbursement under your out-of-network benefits.

If you do not have insurance, payment is due in full at the time of service.  

Any non-covered or cosmetic care is due at the time of service. Method of payment for cosmetic services will be by cash or bank card only.

We appreciate your selecting Integrated Dermatology of Calumet City, LLC for your medical care, and will work hard to serve your needs.

Payment Policy

CONSENT FOR MEDICAL PHOTOGRAPHY & ELECTRONIC COMMUNICATIONS ID CALUMET CITY LLC COSMETIC CONSULTATION FORM