Appointment with Drs. Biernat, Seline or Casey:

Click here to download your packet of forms

Your packet includes:

• Medical History Form
• Patient Demographics Form
• HIPAA Policy
• Billing Policy
• Mohs Information Sheet
• Acknowledgment Form for ASC
• ASC Patient Letter (Required Reading)
• ASC Information Sheet (Required Reading)
• ASC Patient Rights (Required Reading)
• ASC Advance Directives (Required Reading)
• ASC Patient Responsibilities (Required Reading)
• Office of Civil Rights Notice of Non-discrimination (Required Reading)
• Map

Appointment with Drs. Channaiah, Lingam, Mehta, Rupert, Soder, San Filippo; Nurse Practitioners, Kelsie Hammond and Ami Sheth or Physician Assistant, Chris Webber:

Click here to download your packet of forms

Your packet includes:

• Patient Demographics/HIPAA Policy
• Billing Policy
• Map