Visit Request Form

Call, text or fill out the form above to request your visit.

Register with PatientAlly.com once you receive the link. 

On PatientAlly.com

Fill out forms in the Documents section.

Fill out your Medical history & Insurance info.

You can also send a Message with quality photos and/or upload important documents such as forms, referrals, insurance cards, and prior visits with other doctors.

Insurance will be verified by our staff prior to visit time.

Pay a co-pay or visit fee online. A link will be forwarded to you.

For patients with medical insurance.  

If a co-pay is due, only the co-pay and the amount not covered by insurance will be charged. Co-pays are collected prior to your visit. 

It is strongly recommended to confirm your insurance coverage for Dermatologist LLC (Fl) or Helix Dermatology and Skin Surgery Institute, LLC (Oh) prior to your visit. You can do that by going to your insurance company's website or calling them. If a referral letter to see a specialist is needed, request it from your primary doctor or urgent care nurse/physician assistant and upload it to the intake forms.

The patient is fully responsible for unpaid insurance bills.