{"id":97,"date":"2019-07-16T15:42:54","date_gmt":"2019-07-16T15:42:54","guid":{"rendered":"https:\/\/swskin.com\/newsite\/?page_id=97"},"modified":"2022-09-19T21:28:09","modified_gmt":"2022-09-19T21:28:09","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/swskin.com\/index.php\/patient-forms\/","title":{"rendered":"Patient Forms and Information"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;3.22&#8243; custom_padding=&#8221;||3px|||&#8221;][et_pb_row _builder_version=&#8221;3.29.3&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.3&#8243;][et_pb_post_title meta=&#8221;off&#8221; featured_image=&#8221;off&#8221; _builder_version=&#8221;3.29.3&#8243;][\/et_pb_post_title][\/et_pb_column][\/et_pb_row][et_pb_row module_class=&#8221;btn-inline&#8221; _builder_version=&#8221;3.29.3&#8243; background_color=&#8221;#f8f4f5&#8243; custom_margin=&#8221;20px||||false|false&#8221; custom_padding=&#8221;20px|||8px|false|false&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.3&#8243;][et_pb_text _builder_version=&#8221;3.29.3&#8243; background_color=&#8221;#f8f4f5&#8243; border_width_all=&#8221;10px&#8221; border_color_all=&#8221;#f8f4f5&#8243;]<\/p>\n<h2>Patient Forms<\/h2>\n<p>&nbsp;<\/p>\n<p>Paperwork must be completed prior to your appointment. We encourage you to complete these forms and bring them into our office.<\/p>\n<p>[\/et_pb_text][et_pb_button button_url=&#8221;https:\/\/swskin.com\/wp-content\/uploads\/2022\/09\/220919-SWDV-NP-Paperwork.pdf&#8221; button_text=&#8221;Patient Forms in English&#8221; button_alignment=&#8221;center&#8221; button_alignment_tablet=&#8221;&#8221; button_alignment_phone=&#8221;center&#8221; button_alignment_last_edited=&#8221;on|phone&#8221; module_class=&#8221;btn-inline&#8221; _builder_version=&#8221;4.0.6&#8243; button_bg_color=&#8221;#464a58&#8243; custom_margin=&#8221;30px|20px||20px|false|false&#8221; hover_enabled=&#8221;0&#8243; url_new_window=&#8221;on&#8221;][\/et_pb_button][et_pb_button button_url=&#8221;https:\/\/swskin.com\/wp-content\/uploads\/2019\/10\/SWSKIN-Spanish.pdf&#8221; button_text=&#8221;Patient Forms in Spanish&#8221; button_alignment=&#8221;center&#8221; button_alignment_tablet=&#8221;&#8221; button_alignment_phone=&#8221;center&#8221; button_alignment_last_edited=&#8221;on|phone&#8221; module_class=&#8221;btn-inline&#8221; _builder_version=&#8221;3.29.3&#8243; button_bg_color=&#8221;#464a58&#8243; custom_margin=&#8221;30px|20px||20px|false|false&#8221;][\/et_pb_button][\/et_pb_column][\/et_pb_row][et_pb_row module_class=&#8221;btn-inline&#8221; _builder_version=&#8221;3.29.3&#8243; background_color=&#8221;#f8f4f5&#8243; custom_margin=&#8221;20px||||false|false&#8221; custom_padding=&#8221;20px|||20px|false|false&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.3&#8243;][et_pb_text _builder_version=&#8221;3.29.3&#8243; background_color=&#8221;#f8f4f5&#8243; border_width_all=&#8221;10px&#8221; border_color_all=&#8221;#f8f4f5&#8243;]<\/p>\n<h2>General Information<\/h2>\n<p>&nbsp;<\/p>\n<p>Make sure to bring the following items to ALL appointments:<\/p>\n<ul>\n<li>Personal information<\/li>\n<li>Your insurance information<\/li>\n<li>A list of your current medications<\/li>\n<\/ul>\n<p>A method of payment for services and co-payments for each visit. We accept Visa, MasterCard, Debit Cards, Checks, Cash and CareCredit.<br \/>\nIf we are unable to verify your insurance information, you are not insured, or if we do not participate in your plan, you will need to pay for your visit in full before you leave our office.\u00a0 Please check our Participating Insurance List to ensure that we are still participating in your plan. We will also verify your insurance upon arrival.<\/p>\n<p>If you must cancel or change your appointment, please call us at 512\u00b7444\u00b77208 at least 24 hours in advance to allow us time to book another patient who needs care.<\/p>\n<p>Please call our office if you have questions regarding:<\/p>\n<ul>\n<li>Medication or treatment-related questions<\/li>\n<li>Lab test results<\/li>\n<li>Insurance-related questions<br \/>\n<strong>* For prescription refill requests, please contact your Pharmacy directly.<\/strong><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.29.3&#8243; custom_padding=&#8221;0px|||||&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;3.29.3&#8243; custom_padding=&#8221;4px|||||&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.29.3&#8243;][et_pb_button button_url=&#8221;@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEwNCJ9fQ==@&#8221; button_text=&#8221;Insurance Information&#8221; button_alignment=&#8221;center&#8221; _builder_version=&#8221;3.29.3&#8243; _dynamic_attributes=&#8221;button_url&#8221;][\/et_pb_button][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.29.3&#8243;][et_pb_button button_url=&#8221;@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjE2NzAifX0=@&#8221; button_text=&#8221;Patient Bill Pay&#8221; button_alignment=&#8221;center&#8221; _builder_version=&#8221;3.29.3&#8243; _dynamic_attributes=&#8221;button_url&#8221; button_bg_color=&#8221;#464a58&#8243; custom_margin=&#8221;30px||||false|false&#8221; custom_padding=&#8221;10px|64px|10px|64px|true|true&#8221;][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patient Forms &nbsp; Paperwork must be completed prior to your appointment. We encourage you to complete these forms and bring them into our office.General Information &nbsp; Make sure to bring the following items to ALL appointments: Personal information Your insurance information A list of your current medications A method of payment for services and co-payments [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":102,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:themeisle-blocks\/advanced-columns {\"id\":\"wp-block-themeisle-blocks-advanced-columns-a6f5f85d\",\"columns\":1,\"layout\":\"equal\"} -->\n<div class=\"wp-block-themeisle-blocks-advanced-columns has-1-columns has-desktop-equal-layout has-tablet-equal-layout has-mobile-equal-layout has-default-gap has-vertical-unset\" id=\"wp-block-themeisle-blocks-advanced-columns-a6f5f85d\" style=\"border-width:0px;border-style:solid;border-color:#000000;border-radius:0px;justify-content:unset\"><div class=\"wp-themeisle-block-overlay\" style=\"opacity:0.5;mix-blend-mode:normal\"><\/div><div class=\"innerblocks-wrap\"><!-- wp:themeisle-blocks\/advanced-column {\"id\":\"wp-block-themeisle-blocks-advanced-column-eed64529\",\"columnWidth\":100} -->\n<div class=\"wp-block-themeisle-blocks-advanced-column\" id=\"wp-block-themeisle-blocks-advanced-column-eed64529\" style=\"border-width:0px;border-style:solid;border-color:#000000;border-radius:0px\"><!-- wp:paragraph -->\n<p>Please bring a method of payment for services and co-payments for each visit. We accept Visa, MasterCard, Debit Cards, Checks, Cash and CareCredit.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If we are unable to verify your insurance information, you are not insured, or if we do not participate in your plan, you will need to pay for your visit in full before you leave our office.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading -->\n<h2>Information For Current Patients<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph -->\n<p>We have recently upgraded to an electronic medical record system, which requires new paperwork to be completed. We appreciate your patience regarding this one-time inconvenience.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you are a new patient to our practice or your last visit was before March 1, 2016 please complete and bring your appointment a newly completed:<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li><a rel=\"noreferrer noopener\" href=\"https:\/\/swskin.com\/wp-content\/uploads\/SWDV-NP-Paperwork-082018.pdf\" target=\"_blank\">Patient Paperwork in English<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/swskin.com\/wp-content\/uploads\/PtInfoSheet3-2017-Spanish.pdf\" target=\"_blank\">Formulario de informaci\u00f3n para el paciente en espa\u00f1ol<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/swskin.com\/wp-content\/uploads\/PtMedHxForm2-2016-2017-Spanish.pdf\" target=\"_blank\">Formulario de Historia M\u00e9dica del Paciente en espa\u00f1ol<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/swskin.com\/wp-content\/uploads\/HistoryIntake2017-Spanish.pdf\" target=\"_blank\">Historial del paciente y formulario de admission en espa\u00f1ol<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/swskin.com\/wp-content\/uploads\/PatientPermission_Consent2017-Spanish.pdf\" target=\"_blank\">Formulario de Consentimiento del Paciente en espa\u00f1ol<\/a><\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>Make sure to bring the following items to ALL appointments:<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>Personal information, if it has changed since your last visit<\/li><li>Your insurance information<\/li><li>A list of your current medications<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>You can call us at 512\u00b7444\u00b77208<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:list -->\n<ul><li>to confirm your appointment date and time<\/li><li>for medication or treatment-related questions<\/li><li>to obtain lab test results<\/li><li>for insurance-related questions<\/li><li>to cancel an appointment, please notify us 24 hours in advance.<\/li><\/ul>\n<!-- \/wp:list -->\n\n<!-- wp:paragraph -->\n<p><strong>* For prescription refill requests, please contact your Pharmacy directly.<\/strong><\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Please check our Participating Insurance List to ensure that we are still participating in your plan. We will also verify your insurance upon arrival.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Using our Automated Appointment Reminder System, we will notify you of the date and time of your scheduled appointment two days before your visit.<\/p>\n<!-- \/wp:paragraph --><\/div>\n<!-- \/wp:themeisle-blocks\/advanced-column --><\/div><\/div>\n<!-- \/wp:themeisle-blocks\/advanced-columns -->","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/pages\/97"}],"collection":[{"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/comments?post=97"}],"version-history":[{"count":2,"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/pages\/97\/revisions"}],"predecessor-version":[{"id":5528,"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/pages\/97\/revisions\/5528"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/media\/102"}],"wp:attachment":[{"href":"https:\/\/swskin.com\/index.php\/wp-json\/wp\/v2\/media?parent=97"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}