Please complete the Patient Consent Form, Patient Registration Form and
Medical History Questionnaire and return them to us at least one week prior to your first visit. Please review and sign the Financial Policy form and bring it to
- Patient Registration Form
- Initial Intake Form
- Notice of Privacy Practices
- Consent to Treat Minors
- Financial Policy Form
If you are unable to mail the completed forms to us at least one week prior to your visit, you also may bring them to your first appointment.
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking on the Get Adobe Reader icon.
Referrals and Payment
Please be sure to obtain a current referral from your primary care provider prior to your visit if your health plan requires one. Bring your referral, the name of your primary care physician, and your health insurance card to every appointment. Copayments are expected at the time of your visit.
SSDP accepts most major insurance plans. Please contact our Billing Department at 508.535.DERM (3376), Option 5, if you have questions about your insurance coverage.
The following insurance plans are no longer accepted at SSDP:
- MassHealth (Medicaid)
- BMC Healthnet
- Neighborhood Health Plan
Questions About Your Skin
In order to provide you with comprehensive care for your skin, our doctors will make every effort to help you prioritize your concerns and address them in a thorough and timely fashion.
Medical Record Release Authorization
If you have previously seen one of our dermatologists in another office, or if you have seen another dermatologist in a different practice, you will need to provide us with your Medical Record. Please click to download the Medical Record Release Authorization Form, fill it out, and send it to the office at which you were seen in the past so that your medical record can be released to South Shore Dermatology Physicians. Your Medical Record should be mailed to:
South Shore Dermatology Physicians
31 Roche Bros. Way, Suite 200
No. Easton, MA 02356
Pre- and Post-Care Instructions
It is important to follow your doctor's pre- and post-care instructions for a variety of medical, surgical and cosmetic procedures provided at SSDP. Download your Pre- and Post-Care Instructions here.
- Efudex 5% | Fluorouracil 5% | Carac 0.5% Instructions
- Imiquimod (Aldara®) Cream Instructions
- Information for Patients Undergoing UVB Phototherapy
- Sculptra Aesthetic Post-Op Instructions
- Vbeam Before & After Care Instructions
- Wound Care Instructions
Please request your prescription refills at the time of your visit. If a refill is required between visits, phone our office during regular business hours with the name and phone number of your pharmacy; name of the medication needed; number of pills taken each day; and strength of each dose. If the medication needed is a cream or a lotion, please include the number of times each day the medication is applied, and strength of the medication. Please allow up to 48 hours for your refill request to be completed.
Please be aware that our practice may not be able to provide a prescription refill prior to your visit if you have not seen one of our physicians for more than 6-12 months. Many medications require careful follow-up and monitoring for potential side effects, and this policy has been implemented to better serve our patients.