Patient Forms

If you are a new patient, or if it has been greater than two years since your last visit, there are forms that will need to be completed. Our paperwork is available to download and complete at your leisure. We know that no one enjoys filling out forms, and we have strived to streamline our paperwork.

Required Forms

The link below contains the following required forms:

Medical History
The Medical History Form is crucial in providing you with the best care possible. Answer the questions to the best of your ability. If you take multiple medications, feel free to bring a separate list for us to copy.

Patient Information
Our Patient Information Form provides us with the information we will need to file a claim with your insurance carrier. Please pay extra attention to the bottom of the form, as this is where you will be able to authorize us (if you so desire) to discuss your medical information with the individuals of your choice.

Receipt of Notice of Privacy Practices
This form is filed in your chart to show us that you have received our most current Notice of Privacy Practices, as per HIPAA regulations. A physical copy of the Notice will be available for your records when you come into the office, or it can be downloaded here.

Download the Required Patient Paperwork (PDF)

Other Forms

Please review the following forms to determine whether or not you wish to complete them:

Photography Consent
Photographs are sometimes indicated during your visit. An example of this would be to track your progress while using a medication. In order for photographs to be taken, the following form must be completed.

Download the Photography Consent Form (PDF)

Credit Card Authorization Form
Please review our Credit Card Authorization Policy. Many patients find this system helpful when managing health care expenses such as co-payments, deductibles, and co-insurance.

Download the Credit Card Authorization Form (PDF)

Privacy

At the Bikowski Skin Care Center, we take your privacy seriously. Maintaining the confidentiality of your information is our top priority. Our complete Notice of Privacy Practices is available for download here, and a paper copy is always available in the office. If you have any questions about the Notice, contact the privacy officer located at the top of the Notice. 

Download the Notice of Privacy Practices (PDF)

Convenient and Timely Appointments
  • Please call us at 412.741.2810
  • Monday–Friday, 8 a.m.–5 p.m.
  • Or, fill out our contact form.

We will try to schedule for your convenience, and if the situation is urgent, you may be told to "come right in." The appointment schedule is planned to minimize the time that you have to wait in the reception area.