Albemarle Dermatology
Associates
3350 Berkmar Drive
Charlottesville VA 22901
(434) 923-4651 phone
(434) 964-3636 fax
Signature Medical Spa
434-923-4646 phone
www.signaturemedspa.com
All Patients
- Please bring your insurance card and referral from your Primary Care Provider if required by your plan.
- Copay is due at time of registration
- If you have no insurance or are otherwise paying with cash on your own, you will need to arrange payment options with our billing office.
- Children under the age of 18 are required to be accompanied by a parent. A temporary guardian is allowed if there is written authorization from a parent or legal guardian.
- In addition to the above, we recommend printing and completing the following forms prior to your appointment. This will help make your office visit more efficient.
Each document is in .pdf format, and requires
Acrobat Reader to open.
New patient forms:
Established patient forms:
Other downloads:
Payment & Insurance
We accept most insurances including most that are accepted by Martha Jefferson Hospital. We will file insurance claims for those plans not listed. To comply with regulations of your insurance company, please bring your CO-PAYMENT. Payment is due at the time services are rendered and can be paid by Visa, Mastercard, check or cash.
Check with your insurance company to see if you need a referral, if you do, contact your Primary Care Physician. You are responsible for obtaining any required referral from your Primary Care Physician prior to your appointment. You are responsible for your bill if you do not obtain proper authorization from your insurance. PLEASE BRING YOUR INSURANCE CARDS TO YOUR VISIT.
Albemarle Dermatology Associates participates with the following insurance plans:
| Anthem Chickering Cigna Community Health |
Coventry Medicare Southern Health |
Tricare for Life VHN Medicaid |
For financial or billing questions, contact our office at (434) 923-4651.