Patient Information

Preparing for Your Visit

The entire staff at Commonwealth Dermatology aims to see our patients in a timely manner because we care about your time.  In addition to completing the forms below, we also ask the following:

* Please arrive 15 minutes early prior to your scheduled appointment time
* Please bring your insurance cards, photo ID, and any applicable referral
* Any copay, coinsurance or deductible is collected at the time of visit.
* If you are unable to make your appointment please provide 24 hours notice by calling or sending a portal message.  Failure to do so could result in a $50 no show fee.

General Dermatology:

We've made it easier to register for your visit by offering our forms online!  Simply complete the forms below and bring them in at the time of your visit.

**Currently our online forms are not accessible.  For your convenience, you can print off the PDF packet to complete and bring to your visit.**

  • Patient Registration Packet [PDF] *Please complete these forms only if you have not been seen within the current calendar year, or changes have occurred.
  • Personal Medicine Form [PDF]  *Please complete this form only if you have not been seen within the current calendar year, or changes have occurred.

Referral Information:

Patients being referred to Commonwealth Dermatology will need to have this form completed by the referring provider

  • Referral Request Form [PDF] - attach this form to all corresponding documentation and fax to the practice, 804-288-7135, prior to the 
                                                                                 patients appointment.

Medical Records Form:

  • Records Release Form (From another practice to Commonwealth Dermatology) [PDF]
  • Medical Records Release Form (From Commonwealth Derm. to you) [PDF]


Commonwealth Dermatology participates with the following insurance companies:

  • Aetna - PPO, American Continental
  • Anthem BC/BS & Healthkeepers
  • Cigna - PPO, Health & Life, Great West, Mid-Atlantic
  • MDIPA Optimum Choice UHC
  • Medicaid - Straight, Aetna Better Health
  • Medicare -
  • Medicare Advantage PPO's - Anthem, Humana, United HealthCare
  • Railroad Medicare
  • Optima Health Plans (Sentara) - Commercial
  • Humana Military Tricare
  • Tricare for Life
  • United Healthcare
  • Multiplan including Private Healthcare Systems (PHCS)
  • Virginia Health Network
  • GEHA
  • Humana HMO
  • Anthem Medicare Advantage HMO 
  • ALL Bon Secours Mercy Health Plans (Medical Mutual of Ohio)

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