248-353-0880 CONTACT US We are currently welcoming new patients. You will find new patient forms below for your convenience. Please download our Patient Information Sheet. It s provided in both Word and PDF forms. The PDF form can be filled out electronically. You can use the usual Adobe Acrobat Reader DC, available as a free download at get.adobe.com/reader. You can then save it on your computer and email the completed form using the contact information below. You can also download the Word version of the form, make your changes, then scan and email back to the address shown below. Faxed forms are also acceptable, or you can print and bring a copy to the office. Don’t worry, we have extras if you forget them. Email forms to: appointments@northwestdermgroup.com Fax forms to: 888-368-7898 Your First Visit On the day you arrive at our office, we will ask you for a copy of your driver’s license and insurance card, as well as a referral from your primary care doctor, if needed. In addition, we will ask you to fill out patient information forms. For your convenience, you may download these forms through the website and complete these prior to your visit. Patient Information Sheet (Doc Version) Patient Information Sheet (PDF Version) HIPAA Privacy Notice Nondiscrimination Notice Interested in becoming a new patient? Simply call us at (248) 353-0880 and have your insurance card ready, along with the name of your primary care physician. We participate with most major health plans. Please contact us to verify that we are a participating provider. Please remember that many cosmetic treatments (such as chemical peels, microdermabrasion and laser) are not covered by insurance. Insurance Plans We Accept Aetna (Commercial & Medicare) Aetna Better Health APCN Ascension Smart Health BCBSM (Blue Cross Blue Shield of Michigan) Blue Care Network (Commercial & Medicare) Cigna Cigna (HAP Preferred) HAP Commercial HRGI Humana (Medicare) Oscar Health Priority Health (Commercial & Medicare) Total Healthcare TRPN (Three Rivers Provider Network) United Healthcare (Commercial & Medicare) OTHER FORMS OF PAYMENT: Cash, Check, Credit Card We're a Patient-Centered Medical Home. Learn More 32270 Telegraph Road, Suite 200 Bingham Farms, MI 48025 Phone: 248-353-0880 Fax: 888-368-7898