Patient Forms

Please read carefully, fill out and sign ALL the forms listed below in order to expedite your registration prior to your initial scheduled appointment at Bergen Dermatology.

New Patient form (PDF)
Credit Card Authorization (PDF)
PHI-Consent-Form (PDF)
Financial Disclosure Form.doc


Bergen Dermatology currently participates in the following plans: 

* Please note: We do not accept student insurance plans
** Please call us with any questions regarding in and out-of-network insurance participation.**