Our Location & Patient Information

DR. POLINGER TREATS CHILDREN AND
ADULTS OF ALL AGES

When you call for your first appointment, please have your insurance card ready. We ask for your insurance information before your visit in order to verify your insurance. This is a necessary step if you will be using your insurance as payment for services rendered. This will also shorten your waiting time in the waiting room prior to seeing the doctor. If we are unable to verify your insurance prior to your scheduled visit, we will ask you to pay in full for services rendered. If your insurance company does pay, we will send you a refund as per your insurance company directions within 30 business days.

Patient information for
our practice

In order to prepare for your first office visit, please print and complete the patient information forms on this web site.
 Bring them with you for your first visit. Also bring your current insurance card and 
photo ID such as driver’s license or passport, or other type of photo ID.

Doctor giving treatment to a patient in Sugar Land

Patient Information and Forms

Click here for NEW PATIENT FORMS


Click here for NOTICE OF PRIVACY

Click here for FINANCIAL POLICY

Policies

APPOINTMENT POLICY

Please call us (281) 491-9278 at least 24 hours in advance to reschedule if you are unable to keep your appointment. This would allow someone else to take your place. If you arrive late for your scheduled appointment, we will try to accomodate you. You may have to wait while we work you in, or you may reschedule. If you simply do not show up for your appointment we may assess a $25.00 charge. Our goal is to make unused appointments available for other patients and not to collect missed appointment fees.

COSMETIC APPOINTMENT POLICY

To hold your cosmetic procedure appointment, a $100.00 deposit is required. As we schedule a large block of time for your cosmetic procedure, we regretfully will have keep your deposit if you do not show up. Should you have any questions or concerns please do not hesitate to call us at (281) 491-9278.

We look forward in serving you in your dermatologic care.

FINANCIAL POLICY

By signing the financial information form, you acknowledge full responsibility for the payment of services rendered. Insurance coverage is a contract between you and your insurance carrier. As a service to you, we will file your insurance claim if you assign the benefits to the doctor. Prior to service, we will collect your office visit co-pay as per your insurance company’s directions. If a procedure is performed, we will collect the applicable deductible and/or co-insurance. Your insurance company may expect you to pay higher amounts for visiting a specialist such as a dermatologist.

If the dermatologist performs any of the following: skin biopsy, injections, curettage (scraping), electrodessication (burning), freezing or excising a lesion or growth, your insurance company may consider this office surgery subject to a deductible. Please notify us immediately if your insurance carrier changes or is terminated so that we may process your claim in a timely and accurate manner. If you fail to give us correct information, we may have to bill you for services rendered. If your insurance company does not pay your insurance claim within 90 days, we may ask that you assist us by calling your insurance company for claim status. We may also have to start billing you for payment of your medical service.
Location map in Sugar Land
Contact us at:
Phone (281) 491-9278       Fax(281) 491-3376
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