Patient Forms2018-11-16T20:45:20+00:00

PATIENT RESOURCES

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 sign the forms below.
  • 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
  • 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.