Adult, Pediatric & Cosmetic Dermatology, Laser & Skin Surgery | Tucson, AZ | Botox
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All email messages sent over the internet are not encrypted, therefore, they are not protected. Patients should not use email communication containing sensitive or private health care information or for urgent health care matters.

Please allow 24 – 72 hours for a response to your email. If you have medical issues or more urgent concerns, please contact us at (520) 795-7729.

For medical emergencies, please call 911.

Thank you.

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If you are an existing patient, we now offer PATIENT PORTAL. For more information, please click here.  

Patient Registration


A Warm Welcome to Our New Patients

Patient Forms & Information


1 New patients: Please print, fill out, and bring the New Patient Forms with you to your first visit at our office. Please download the forms below.

2 If you are an existing patient, you may also use these forms to update your information. 

3 Please arrive 15 - 20 minutes early for your paperwork to be processed and to keep your appointment running on time.  

4 Please bring your Photo ID and Insurance Card.

5 For a list of Insurances accepted,
click here.
 

 

A cactus forest, photo by Dr Gerald Goldberg

NEW PATIENT FORMS
Registration
Medical History

HIPAA / Advance Directive
Sclerotherapy Questionnaire (Sclerotherapy patients only)

OPTIONAL FORMS
Credit Card On File Agreement (optional)
Cosmetic Questionnaire (optional)
Topic of Interest Menu (optional)

If the patient is under 18 years of age, please download and complete this form:
Consent for Treatment of Minor



 

Section 1557 Nondiscrimination Statement
Pima Dermatology, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Pima Dermatology, PC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. To learn more, please click here.


Patient Bill of Rights and Responsibilities

Patients have the right to considerate and respectful care. To read our 
Patient Bill of Rights and Responsibilities, please click here.

HIPAA Notice of Privacy Practices
This Notice of Privacy Practices describes how we, our Business Associates and their subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.To read the Notice of Privacy Practices in full, please click here

POLICIES:

Understanding our commitment to you and your financial responsibility to us is an essential component to establishing and maintaining a strong patient/practice relationship. In order to achieve this, we offer the following information regarding our office policies: Click Here


PAYMENT:
 
  • If you are a self-pay patient, your insurance company is not contracted with us, or you are receiving elective or cosmetic services, please be aware that payment is due at the time of service.
  • Some cosmetic services require prepayment (i.e. Botox treatments, dermal fillers, laser skin resurfacing, etc.).
  • As a courtesy to our patients, we file medical claims with most insurance companies. However, the involvement of the insurance companies makes the billing process extra complicated. If you have any questions regarding your billing statements, please let us know so that we can help you. Our business office can be reached at 520.396.1860.

FORMS OF PAYMENT ACCEPTED:

Cash
Personal Checks
Debit Cards (with a Visa logo)
Visa, Mastercard, American Express, & Discover
CareCredit


NO SHOW OR CANCELLATIONS:

  • As a courtesy, we will attempt to contact you prior to your visit via phone and/or email to confirm your appointment.
  • If you need to reschedule or cancel your appointment, please call our office at 520.795.7729 at least 48 hours in advance
  • If you miss an appointment, or cancel an appointment without a 48 hour notice, you may incur a charge of $40.00 or more, depending on the type of service scheduled. A scheduled Mohs surgery that is not cancelled 72 business hours prior will be subject to a $100.00 no show fee. Cosmetic and Laser procedures require a minimum of a 48 hour notice to cancel or reschedule; failure to do so may result in deposit being forfeited.

We look forward to your visit. If you have any questions or concerns, please contact us at 520.795.7729.

Map to Pima Dermatology

We are conveniently located north of Tucson Medical Center, on Glenn Street     
(between Swan and Craycroft).
Printable Map


 

Office Wi-Fi Available

Pima Dermatology is pleased to offer free Wi-Fi for our patients to use when visiting our office. Our Wi-Fi is secure, but separate from the system used within our office for medical records. Therefore, there is no possible exchange of protected and private information.

To access our wireless guest network, please ask the Front Desk or Back Desk for the Wi-Fi password to connect. For your convenience, you will be able to connect anywhere within our office.