REGISTRATION FORMS

Fill Out the Forms for Convenient Medical Treatment

Take a moment to complete the paperwork in the comfort of your own home. Instead of trying to remember everything that needs to be marked down with a ballpoint pen on a wooden clipboard, you can save both time and stress by completing your registration forms beforehand.
Registration Form Health History Social History Consent Form for Treatment of a Minor Consent for Medical Photography and Electronic Communications ID Calumet City LLC Cosmetic Consultation Form

Save Your Time by Coming Prepared With the Following Documents

  • Driver’s license or a valid picture ID
  • Insurance information
  • Copayments are due at the time of each visit
  • List of current medications
  • Completed registration form
Dermatology Services

Experience the Difference in Our Dermatology Services

  • FREE cosmetic consultation
  • Evening and Saturday appointments
  • Personal service
  • Individual attention
Woman

Hassle-Free Appointment Scheduling

Schedule your appointment conveniently. Your appointment time is reserved especially for you. Calumet Dermatology Assoc patients must give a 24-hour notice for cancellations. There will be a $35 non-cancelled appointment fee charged to your account, if timely notice is not made.

Read More About Our Payment Policy

If we are contracted with your insurance, we will bill your insurance charges. It is our payment policy to collect the appropriate payment due from the patient at the time the service is rendered. This may only be your copayment, deductible, and/or co-insurance, but we do ask for payment at the time of your visit.

If we are not contracted with your insurance, we can still see you; however, payment is due in full at the time of service. You will be given a receipt so that you can file with your insurance for reimbursement under your out-of-network benefits.

If you do not have any insurance coverage, payment is due in full at the time of service. Any non-covered or cosmetic care is due at the time of service. The method of payment for cosmetic services will be by cash or bank card only. We appreciate your selection of Calumet Dermatology Assoc for your medical care and assure that we will work hard to serve your skin care needs.
Call us today at 
708-862-1290 (IL) or 
219-865-8800 (IN) to schedule an appointment

We are dermatologists who tend to any medical condition, regardless of your skin type!

BBB Logo
Share by: