Insurance and Forms

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Patient Registration Form

Download our patient registration form in PDF format to expedite your visit to Elevated Dermatology. If you prefer, you can fill out your forms through our portal (call or text 720-851-5200 for details) or come to your appointment 30 minutes early and fill out your forms in our office.

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Patient Registration Form

Parent or Guardian consent for an appointment and/or procedure form

Download our parent or guardian consent form in PDF format if you want your minor child to be seen for an office visit or have any procedure done without you present. Send completed form to patient@elevatedderm.com or text a photo of the completed form to 720-851-5200. Parent or guardian must be present at first visit. 

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Parent or guardian consent for appointment and/or procedure for minors

Financial Responsibility and Insurance

Understanding your financial responsibility is an essential component in establishing and maintaining a strong patient/practice relationship. Your insurance coverage is a policy that you have purchased and is a contract between you and your insurance company. It is your responsibility to know and understand the terms, guidelines and limitations of your coverage. It is also your responsibility to advise us of any changes in your insurance, your address or your employer. Please remember that it is ultimately your responsibility for the payment of all medical bills.

We ask that you confirm that Elevated Dermatology is in network with your insurance plan prior to being seen. This can be done by calling the customer service number on the back of your card or logging into your insurance company’s website and checking through their system.

If your insurance requires a referral, ensure that we have this on file prior to being seen. Your visit will not be covered, resulting in a large out of pocket expense to you.

If we do not participate with your insurance carrier, you have the option to pay a discounted self pay rate which is due on the date of service.

We do not accept the following insurances (this may not be a complete list):

Aetna

Aexcel

Cigna

Local Plus

SureFit

Connect

Colorado Health Partners

All plans

Colorado First Health/Medicaid

Friday Insurance

All plans

Humana

HMO X

Multiplan

Worker’s Comp

Auto Medical

Value Point

PHCS 

PHCS Savility

Rocky Mountain Health Plans

Medicare Cost

Denver Health

All plans

Kaiser

All plans except those that are in PHCS network

United 

Charter EPO/HMO/HMO Plus/POS

Compass EPO/Exclusion/HMO/HMO Plus/POS

Core EPO/HMO

Core Choice Plus

Navigate EPO/HMO/HMO Plus/POS

Veterans Affairs CCN

REQUEST AN APPOINTMENT

Request an appointment at our Parker, CO office. To schedule by phone, call us at 720-851-5200.
Visit our Contact page for location map and hours.

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