Patient Forms
Basko Dermatology is thrilled that you have chosen us for your dermatological needs. Please note the following information regarding your appointment with us.
- Prior to your first appointment, please print, complete and/or sign the following forms:
- Upon making your first appointment, a Portal link will be sent to your email address with information on how to complete your medical history online prior to your appointment.
- Please arrive 15 minutes prior to your appointment time.
- Please bring the following items/documents with you at your appointment:
- Valid Photo ID
A valid photo ID is required to verify your identity. You cannot be seen for your appointment and will be asked to reschedule if you do not have a photo ID with you. - Current Insurance Card
A valid insurance card is required in order for us to submit claims to your insurance. If you do not have an insurance card, then you will be self-pay and required to pay in total at the time of service. - Valid Credit Card
A credit card will be kept on file and charged for any remaining balance after your insurance has paid (please refer to our ‘Financial Policies’). - List of Current Medications
- Valid Photo ID
- You will complete the Patient Registration process upon check in to our office.
- Should you have any questions prior to your appointment, please call us at 630-596-8045. Our staff are happy to assist you to make this process as seamless as possible and your experience with us enjoyable.