New Patient Forms

New patients are always welcome at Lubbock Dermatology and Skin Cancer Center. If you are a new patient, please fill out the forms below and bring them with you to your first appointment.

New Patient Information

Note: You will need Adobe Acrobat Reader to view these forms. If you do not have Adobe Acrobat Reader, you can download it here.



Always bring your current insurance card when you visit us. Co-pays for office visits and procedures are due at the time of visit.

We accept Medicaid (by physician referral only) and Medicare. Other insurance policies accepted at our office are:

  • FirstCare
  • Blue Cross/Blue Shield
  • HMO Blue
  • Accountable Health Plans
  • Insurance Management Services
  • TRS Coordinated Care
  • National Healthcare Alliance
  • HealthSmart
  • Texas True Choice
  • ProNet

Billing & Payment

Lubbock Dermatology and Skin Cancer Center accepts the following credit cards:

As a service to our patients, we are pleased to offer the CareCredit card, North America's leading patient payment program. CareCredit has a full range of payment plans to meet every financing need, including no interest and low interest options, each with low monthly payments and no upfront costs. It's easy to apply and you'll receive an online decision in seconds. Click here to apply now or contact us for more details.

Prescription Refills

If you need a refill on your prescription, contact your pharmacy first, since many prescriptions may still have refills of which you are unaware. Have the pharmacy contact us with the medication that needs to be refilled. We generally will get these approved the same or next business day.

If it has been more than a year since you have been seen, you will need to schedule an appointment. We will not refill prescriptions for patients who do not keep appointments. We must make sure the medications are working appropriately and not causing known or unknown side effects or problems. Also, newer, more effective therapy may be available for your condition.


At Lubbock Dermatology and Skin Cancer Center, we provide comprehensive dermatology care that includes diagnosis and treatment of common as well as uncommon skin conditions. We see patients of all ages including infants, children, teenagers, adults, and the elderly.


3601 22nd Street

Lubbock, TX



Tel: (806) 796-7193

Fax: (806) 796-0034


© 2018 Lubbock Dermatology and Skin Cancer Center