Skin Care Product Store Toll Free Ordering 1-800-393-3848
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Skin Care Product Store Toll Free Ordering 1-800-393-3848 |
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Registration Forms
Dear Patient,
Thank you for contacting our office, and we look forward to meeting with
you.
In order to save you time when you come in for your appointment, our
registration forms are available below. Please complete them at home and
then bring with you. There are two versions of each form and you're
welcome to use whichever version you prefer.
If you have Microsoft Word
We suggest that you use the Word version of the forms. Simply open each
form in Word, and you can use your "Tab" key to move from field to field,
typing in the information required. If you're unsure of what to enter, use
the "F1" key on your keyboard to open a pop-up box with instructions for
that field. When the form is complete, print two copies.........one for
your records and one to bring with you to your appointment. You can save
the completed form to your hard drive by using the "Save As" command in the
File menu in Word. Click File, then "Save As", and save the form to the
sub-directory of your choice on your hard drive.
If you don't have Microsoft Word
We include the PDF version of each form for those who don't own Word. These
documents can be opened with the Adobe Acrobat Reader. If you don't have
the Acrobat Reader, Adobe offers a FREE version for download, and you can
get a copy by clicking
here. Once you have the Free Reader, you can open the PDF documents
and print them, then fill them out by hand (we're sorry, but Adobe doesn't
include form filling with their free Reader anymore).
If you have any questions or concerns about the forms, please don't hesitate
to call our office at 407-352-2444 and we'll be happy to assist you!
Other New Patient considerations Please be aware that only certain insurance plans are accepted. It is your responsibility to verify that we are on your plan. Please call the phone number on the back of your card and confirm that we are a physician on their panel. We will still be happy to see you if we are not on your plan, but we cannot file your insurance and you will be expected to pay in full at the time of your visit. We offer a 20% discount for those out of network that pay at the time of their treatment. In the state of Florida, if you are on a HMO plan, you are allowed five (5) visits a year without a referral from your primary care doctor. It is your responsibility to get a referral for the sixth (6th) visit to see Dr. Meisenheimer. Due to the new HIPPA laws passed by the Federal Government you will be required to bring a photo I.D. Also, if the patient is under the age of 18 we cannot see them without a parent or legal guardian. Please do not send your child with family members such as Grandma or Aunt until we have written authorization from you to see your child in the care of another adult. Ladies, please do not wear any makeup, i.e., foundation or cover up. You may want to bring makeup with you to apply after the examination. If you should have any other questions, please do not hesitate to call our office and speak to one of our staff at 407-352-2444. For directions click here Directions We look forward to seeing you!
Dr. John L. Meisenheimer, MD
South Orlando Dermatology
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Last modified: 10/19/08 |