New Patient Forms
For your convenience, please fill out the following forms and bring them to your appointment:
(The Medicare One Time Authorization is required for patients with Medicare Part B coverage.)
(The Medicare Secondary Payer Questionnaire is required for patients with Medicare Part B coverage.)
Free Acrobat Reader is needed to view the forms. You can download it here.
South Lincoln Dermatology Clinic accepts most major medical insurance plans including Medicaid and Medicare.
Note: Dr Weir is not an in network provider for CHI (Catholic Health Initiative). The rest of our providers are.
We accept Cash, Check and all major credit cards. You can also securely pay online using the button below.