Welcome to Yorba Linda Dermatology! We understand the importance of finding the right dermatologist to care for the needs of your skin and we thank you for choosing us. Please do not hesitate to call if you have any questions about the information listed below.
Patient Registration and Health Questionnaire
We accept Medicare, Caremore and all major PPOs. If there is any question about the type of plan that you have, please give us a call as we are happy to verify your eligibility prior to your appointment.
We strive to make your visit with us as pleasant and efficient as possible! On your first visit we will need to register you as a new patient in our system. We value how important your time is so filling out the patient registration and health questionnaire ahead of time will help us expedite your registration.
— Patient Health Questionnaire [PDF]
— Patient Registration [PDF]
Don’t forget to bring your insurance card, photo identification and any products or prescriptions used to treat your skin condition with you to your appointment.
Other Patient Forms
— Medical Records – Release or Acquisition
— Mohs Preop [PDF]
— Post-op Care for Sutured Wounds [PDF]
— Post-op Care for Second-Intention Healing/Non-sutured Wounds [PDF]
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.
Before your visit, we will verify your eligibility and insurance benefits. If you have a co-pay amount, it will be collected at the time of service. If your annual deductible for the calendar year has not been met, you will be responsible for any charges incurred during your visit. We accept cash, checks, visa, mastercard, and Amex. Cosmetic procedures are not billed through insurance and are payable in-full at the time of service.
We kindly ask that patients give us 24 hour notice for appointment cancellations. Failure to do so may result in a cancellation fee billed to your account. This allows us time to schedule other patients in need of urgent appointments.
Patients can request that their pharmacy contact our office for a refill or requests can be made by phone during regular business hours. We do not accept refill requests on the weekend or after hours. Please allow two days for the refill to be authorized by the doctor and submitted to the pharmacy.