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Patient Information

Offering the latest in results-oriented cosmetic dermatology

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Patient Information

Offering the latest in results-oriented cosmetic dermatology

Dr. Jeffrey N. Thompson Dermatology

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Note: The above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Please printout and complete the appropriate forms:

Payment Information

Payments and Insurance

Our office accepts payment from most major insurance programs and participates with Highmark Blue Shield. We also accept Medicare Assignment and participate in many managed care plans.

Insurance coverage and requirements vary, depending on your insurer and your policy. It is important for you to check with your insurance company or our office before your visit, to determine which services are covered and whether any special insurance forms will be needed. If you would like assistance with submitting an insurance claim, please ask a member of our office staff.

Payments for deductibles, co-insurance and any charges not reimbursable under your insurance plan are your responsibility and are due at the time of your visit.

For your convenience we accept personal checks, MasterCard, and VISA. A $25 fee will be charged on any returned checks.

For questions regarding statements, billing and insurance coverage, please call (724) 733-7544 and speak with Mary Ellen, the office manager.

We participate with most major carriers:

  • Highmark/Blue Shield
  • Medicare
  • UPMC
  • Health America/Health Assurance
  • Advantra
Contact Us Today

Have questions or concerns? Please call us at (724) 733-7544.

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