Please select the New Patient Registration Form associated with your insurance plan:

NEW PATIENT FORM

AFTERCARE INSTRUCTIONS

ACCUTANE/IPLEDGE

INSURANCE

Accepted Insurance:

  • Aetna PPO

  • Anthem Blue Cross PPO

  • Assurant PPO

  • Blue Cross Blue Shield PPO

  • Blue Shield PPO

  • Blue Shield Covered California

  • Cigna PPO

  • Healthnet PPO

  • Medicare 

  • Medicare Advantage PPO

  • United Healthcare PPO

MEDICAL RECORDS

For Patient

How Long Does a Physician Have to Send Me the Copy of My Medical Records?               

If you made your request in writing for the records to be sent directly to you, Bella Cara will provide copes within 15 days. 

How Can I Get My Medical Records?     

In order to obtain your medical records, we will need you to fill out a Medical Release form. The three methods of obtaining your medical records are: 

  • Fax

  • Mail

  • Pick Up in Person

If your medical records exceed 20 pages, we will send your records by mail or by pickup ONLY. 

For Provider

How Do I Get My Medical Records Transferred to Another Provider/Facility?        

According to the Medical Board of California, transferring records between providers is considered a "professional courtesy" and is not covered by law. There is also no time limit on transferring records. If a patient wants to insure that his or her new doctor receives a copy of his or her medical records from Bella Cara Dermatology, the patient can fill out a Medical Release form requesting a copy of his or her medical records be sent directly to the patient. When the patient receives the records, the patient can provide a copy of those records to any provider he or she chooses.  

We will charge a clerical fee of $25.00 plus a copying fee of $0.25 per page to the provider requesting the medical records. Medical records will not be provided until the fee is paid. 

The three methods of obtaining your medical records are: 

  • Fax

  • Mail

  • Pick Up in Person

If your medical records exceed 20 pages, we will send your records by mail or by pickup ONLY. 

MEDICATIONS LIST

Please provide an updated Medications List for each appointment especially if you are taking new medications or have changes to your list.

PATIENT PORTAL

Why Access Patient Portal?

Your Patient Portal will allow you to access your medical information safely and securely. You will now be able to view, add, and edit your information online, including: 

  • Contact and Insurance Information

  • Medications and Allergies

  • Past Medical History

  • Pharmacy Preference

  • Skin Disease History

  • Social History

  • Test and Results

  • Patient Portal

For log in help, please contact us at (949) 646-7546.