hi there!
Welcome to LifeTime Dermatology
Step One
We would like to know you better. Please provide us with your answers to the following questions.
Step two
Please take a moment to print and fill out the forms below and bring them with you to your initial visit with us:
- Patient Registration
- Patient History
- Medical Update Form
- Financial Agreement
- 24-Hour Cancellation Policy
- Cosmetic Interest Questionnaire
If your son or daughter is under the age of 18 and coming to their appointment without a parent, complete the following form and send it with your child so we may treat them in your absence:
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financing available
Lifetime Dermatology partners with PatientFi to remove cost barriers by offering monthly payment plan options, so more patients can say yes to the elective procedures they want.
accepted insurance programs
- Aetna U.S. Healthcare – EPO, POS, PPO
- Beaumont Employee Health Plan – PPO – UMR
- Beaumont Services Company (BSC) – PPO – UMR
- Beech Street – PPO
- Blue Care Network – HMO
- Blue Cross/Blue Shield – Traditional
- Blue Cross/Blue Shield PPO – (Blue Preferred, Blue Preferred Plus, Community Blue)
- Cigna
- Cofinity (PPOM) – Total Health Care PPO
- DirectCare America (Chandler Group) – PPO Formerly Primary Health Services
- Great West – POS, PPO
- HAP Medicare PPO
- HAP PHP
- HAP HMO (Not Henry Ford)
- Humana Choice Care PPO (Choice Care)
- McLaren PPO Health POS – Must have PCP, but do not need a referral
- Medicare
- Medicare Aetna Open Plan – PPO
- Medicare Plus Blue – PPO
- MultiPlan – EPO, POS, PPO
- Priority Health – PPO & HMO HMO does not need a referral
- Private Healthcare System (PHCS) – EPO, POS, PPO
- Tricare Standard (formerly Champus)
- Tricare for Life (Medicare portion)
- United Healthcare – EPO, POS, PPO
- United Physicians Health Insurance Plan – PPO (UPHIP)
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