Patient Form

OFFICE POLICIES

At Mira Visa Surgical Dermatology, we value your time. We attempt to avoid overbooking our schedule to ensure that we run on time and provide the best experience for your visit. Should you be unable to keep your appointment, please let us know at least 48 hours in advance. Failure to provide advanced notice of cancellation may result in a $50 fee for clinic visits and $150 fee for surgical and procedural visits. These fees are not reimbursable by your insurance company. If you are late to your appointment, we will attempt to accommodate you but may request that you reschedule.

PREPARING FOR YOUR VISIT

WHAT TO BRING:
  • Completed patient forms
  • Pharmacy information
  • Insurance Card(s)
  • Driver’s License
  • List of medications and any relevant medical records

Please consider arriving 10 minutes early for your appointment or 30 minutes early if you need to fill out paperwork.

Thank you and we look forward to serving you!

Download Patient Form

The forms may be completed on your computer using the Fill and Sign function under the Tools tab of Adobe Acrobat.

SCHEDULE A CONSULTATION

Our team of healthcare professionals at Mira Vista Surgical Dermatology in Fort Worth, TX is trained in performing a variety of most-advanced treatments. We are dedicated to your health and comfort as we aim to provide the best service. If you have any health concerns you wish to discuss with us, contact us today to schedule an appointment.