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.
We've made it easier to register for your visit by offering our forms online! Simply complete the forms below and email them directly to us, so you won't have to do it in the office.
- Patient Registration Packet [PDF][Online Form] *Please complete these forms only if you have not been seen within the current calendar year, or changes have occurred.
- Personal Medicine Form [PDF] [Online Form] *Please complete this form only if you have not been seen within the current calendar year, or changes have occurred.
Medical Records Form:
- Records Release Form (THEM to US) [PDF]
- Medical Records Release Form (From Commonwealth Derm. to you) [PDF]
These forms are ONLY for Functional Medicine patients:
- Medical Systems Questionnaire
- General Office Policies
- Female Intake
- Male Intake
- Pediatric Medical Questionnaire
- Protect Health Information
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
- Humana HMO
- Anthem Medicare Advantage HMO
- ALL Bon Secours Mercy Health Plans (Medical Mutual of Ohio)