Patient Information

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New Patient Forms

To fill out and return online, use the forms #1 and #2 . To fill out and bring the forms to your appointment, use the pdf forms. You may fill them out on your computer and print out, or print out and fill out by hand.

Fill out new patient forms below. Please be prepared to show your insurance card along with a photo ID.

Online version of medical forms (forms will be submitted electronically):

Patient Form #1Patient Form #2

Billing

We are currently in-network with Medicare. If you have another insurance provider we would still love to see you! We can provide a detailed receipt with the information necessary for you to submit to your insurance for out-of-network benefits.

For billing concerns please contact the billing department: Phone: 650.551.9700.

E-mail: janet@premier-dermatology.com

Billing department hours: Monday-Thursday 10am-4pm

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