Patient Resources

Exceptional Service – Every Patient, Every Time

Patient Resources

Exceptional Service – Every Patient, Every Time

Bikowski Skin Care Center

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.
Consent for Use or Disclosure of Information
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. In addition, this form is important because it allows you to authorize us (if you so desire) to discuss your medical information with the individuals of your choice.
Financial Responsibility
This form outlines your financial responsibility for out-of-pocket expenses. It also includes important authorizations that allow us to bill (and receive payment from) your insurance provider.

Download Forms

Your Privacy

Privacy Policy

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 listed in the Notice.

Have questions or concerns? Please call us at (412) 741-2810.