Derm Aesthetics & Laser Center

Patient Forms

Derm Aesthetics & Laser Center provides it's patients with downloadable patient History forms to help save time. Just print and fill out the downloadable PDF form. In order for Dr. Caglia to provide a complete and comprehensive medical opinion it is important that he reviews all your medical information. Please be prepared to provide this information (History & HIPPA) to our office. The HIPPA form is a federally mandated form for your medical privacy, and you need only to sign and date it.  Below are links to our patient information forms. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.  Don't forget to bring them to your appointment.

Patient History Form

Credit Card Charge Authorization Agreement

HIPPA Privacy Form

Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Cell Phone Use

When you enter our office it is madatory that all cell phones be placed in the off or vibrate position in order to ensure that the consultation or procedure is respectfully not interrupted.  Your cooperation with this policy will be appreciated by the other patients and the physician.  

Emergencies

Our office provides on-call service for non-life threatening urgencies, 24 hours-a-day, 7 days-a-week. Call (972) 690-7070 and Dr. Caglia will be contacted immediately.  If you believe you are having an Emergency or there is a life threatening condition immediately call 911 and go to the nearest Emergency Facility.

Your Referrals

A patient recommendation of our services is the highest compliment we can receive.

Please know that our appointment book is always open for one of your friends or family members.

Financial Options

Most medical insurance plans will not usually cover cosmetic procedures. Please note that payment is due when services are rendered. Our office is able to assist you with a financing program for elective medical procedures. Patients may be pre-approved for financing with a low-interest monthly payment plan.

Cosmetic Fee Plan can design an affordable repayment plan that works for almost every budget. Your application can be reviewed and approved online in minutes. Simply click on the logo for Patient Financing or ask about patient finance options during your visit

In addition, we also accept the following credit cards for your cosmetic procedures.  Some patients have applied for approval with new low interest credit cards for their procedures by finding the best credit card offers trough www.bankrate.com.

It is our philosophy to help you look your personal best with a minimum of downtime. We are dedicated to providing the highest level of patient care. This includes providing every patient with:

• A caring atmosphere: We take time to listen and answer your questions fully.
• Educational support: We feel that a well-informed patient is one of our best assets in providing successful treatment and prevention. We provide you with a thorough explanation of your diagnosis and treatment options.

APPOINTMENTS:

Please provide us with at least 24 hours advance notice for any appointment changes. This will enable us to better accommodate another patient.

If you are unable to provide care for a small child during your schedualed appointment time please call our office to reschedual until you are able to do so.  This will ensure an uniterrupted visit to our office.

CANCELLATION & "NO SHOW" POLICY

A credit card is necessary to secure an appointment for consultation.  Any cancellation less than 24 hours in advance will be charged $50 to your credit card. Failure to cancel a procedural appointment may be charged one half of the procedure fee.  For those patients scheduling surgical procedures such as Laser Lipo or Fractionated CO2 Resurfacing, 50% of the fee is applied at the time of schedualing and the balance is due 2 weeks before procedure date.  Cancellation of a surgical procedure must be made within 48 hours of the date of your procedure, otherwise a non-refundable fee of 50% of your procedure will be applied.

PRESCRIPTION REFILLS:

Prescription refills are handled during office hours when we have full access to your medical records. Refills are not routinely filled on holidays, weekends, or if you have not been seen for more than six months.

FEES, PAYMENT & INSURANCE:

Most medical insurance plans will not usually cover cosmetic procedures.  Please note that payment is due when services are rendered.  Our office is able to assist you with a financing program for your elective medical procedures if needed.   All elective cosmetic procedures must be paid for in advance.  We do accept all major credit cards and checks from a local bank and proper ID.  In the event you have a special insurance plan we will be happy to assist you with your insurance codes or letter.  Please discuss your finincial concerns with our patient coordinator at 972-690-7070 prior to your appointment.