Patient Forms
	Click below to download.   Patient Registration

Our regular office hours are Monday through Thursday 6:30am to 5:00 pm and Fridays 6:30am to 3:00 pm.

The form to your right can be downloaded and printed at home. By filling out this form ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current insurance information. You will need Adobe Acrobat Reader in order to view the form.

*Office visits:  New Patients and patients who have not seen Dr. Herron within one year must arrive at least 10 minutes before the scheduled appointment time.  This will allow for adequate time to complete/update any required paperwork.  Any patient who is late for their appointment may be asked to reschedule.

*Cell phone usage:  any use of cell phone during a medical visit shows rudeness and disrespect.  There is no phone call that is more important than your time with a physician. Playing games also is clearly disrespectful during the office visit.

*Cancellation policy:  As a courtesy, the office attempts to remind patients of their appointment ahead of time, but ultimately, it is the patient’s responsibility to remember their scheduled appointment.  We require 24-hours notice when canceling appointments.

*No-Show policy:  Missing appointments is disruptive to any medical practice. If you do not intend to keep your appointment, cancel the appointment.  In the future, no-shows or failing to show for your appointment will be subject to dismissal from my practice.

*It is the patient’s responsibility to ensure that any required referrals are current BEFORE the scheduled appointment time.

*Co-Payments:  Co-pays must be paid at the time of check-in.  If your co-pay is not indicated on the insurance card, you may be asked to pay 20% of the total charge for the visit during check-out.  If there is a credit on your account after all insurance payments have been received, a refund will be issued to you.  Cash, checks and all major credit /debit cards are accepted, excluding Discover Card.

*If we participate (are contracted) with an insurance plan under which you are covered, we will bill the insurance carrier for you.  You will be responsible for any remaining balance, including annual deductibles, co-payments, coinsurances, and charges for non-covered or cosmetic services.

*Insurance rebilling charge:  Patients must provide our office with correct and current insurance information.  If the correct insurance information is not obtained before the insurance company’s filing deadline, then the patient will be responsible for the entire cost of the visit.

*Refill policy:  Patients are given enough medication to last until their next visit.  A follow-up visit may be required for prescriptions that are over a year old.  Depending on the situation, a one-time refill may be granted to allow time for a follow up visit to be made.

*There is a $30.00 processing fee for returned checks.

*Herron Dermatology reserves that right to terminate patients from the practice. Reasons for termination may include, but are not limited to, disruptive and abusive behavior, non-payment, failure to follow clinical advice or treatment, and failure to keep follow up appointments.

If you have insurance through a company that we have contracted with, we will bill your insurance company for the visit. We will require a copy of your insurance card and a driver's license. All co-payments, co-insurances and deductibles are due at the time of visit, no exceptions. You will be responsible for any services denied by your insurance carrier as not medically necessary and/or not covered.