New Patient Information 2017-12-08T11:20:37+00:00

PATIENT INFORMATION

Welcome to Our Roanoke, VA Practice!

Skin Care Specialists

We offer you the highest quality medical care in a comfortable, friendly, and personal environment. Dr. Allison K. Divers, and/or one of our physician extenders, Patricia Carlton, N.P., or Terri Blomberg, PA-C, will address your particular concerns and clearly discuss your diagnosis and treatment options. Education is provided as part of all treatments as our goal is for you to knowledgeably participate in your care.

New Patient Forms

For your convenience, the following New Patient forms are available in PDF format. To save time at your appointment, please print out and complete the following forms:

Welcome Letter

Registration Form

Health History Form

Authorization to Disclose PHI (Protected Health Information)

Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Cosmetic Interest Questionnaire

Insurance Information

We participate with the following insurance providers:

  • Anthem
  • Aetna
  • Cigna
  • Southern Health/Coventry Network
  • UHC  (United HealthCare Network)
  • VA Health Network
  • FHN (First Health Network)

We DO NOT accept any Medicare or Medicaid policies even if they fall under any of the above listed health insurance carriers. We are glad to see any such patients with payment due at time of service.

Please call our office with any questions or clarification needed. 540-725-SKIN (7546)

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