The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.
- Office Policies and Consents
- Telemedicine Consent
- COVID-19 Consent
- Parental Permission Form for Minors
- Notice of Privacy Practices
- Nondiscrimination Policies
- Request for Medical Records
- Release of Medical Records
Information for Cosmetic Services
- Botox Q and A
- Botox Instructions Before/After
- Filler Instructions Before/After
- Sculptra Information
- Platelet-Rich Plasma (PRP) Information
- Platelet-Rich Plasma (PRP) Instructions Before/After
- Chemical Peel Information
- Isolaz for Acne Information
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.
Click here to access our Patient Portal.
Billing & Insurance
It is your responsibility to know and understand your insurance plan’s policies. There are a number of different insurance plans and each one has its own unique reimbursement policies. It is your responsibility to notify us of any special requirements within your plan. We accept most insurance plans and will file all claims, including secondary insurance, to the plans with which we participate.
All co-payments and deductibles are collected at the time of service. If you have not met your deductible, we require that you pay a percentage of the contracted fee amount at the time of service. You will receive a bill for the remaining balance. It is important to understand that most insurance companies consider all procedures (i.e. freezing warts, biopsies, etc.) applicable to your surgery deductible (if you have one). If your insurance company denies your bill, you will be held financially responsible. If you have no insurance or if you are having a cosmetic procedure done, the fees will be collected in full at the time of service. If your insurance changes, it is your responsibility to notify our office at least 24- hours before your appointment to make sure we are a provider. Failure to do so may result in needing to reschedule your appointment and a $35 cancellation fee.
You may receive a separate bill for any laboratory tests or pathology services that Dr. Stewart or Dr. Gioe may order.
We accept the following forms of payment: Personal Check, Cash, MasterCard, Visa, American Express, and Discover.
Returned Check Fee/Collections
There will be a $35.00 charge for all returned checks. If it is necessary to collect unpaid fees for services rendered, you will be responsible for the charges assessed by the collection service, legal counsel, or court.
At all initial visits, minors must be accompanied by a parent or legal guardian. Thereafter, if a minor is attending an appointment without a parent, payment is still expected at the time of service. Please provide written consent for all unattended minors – Parental Permission Form for Minors
Our physicians and staff strive to be on time. In order to help our office run smoothly, we ask that you do the following: If you are running more than 15 minutes late, please call to let us know as we may need to reschedule your appointment.
If you need to cancel or reschedule an appointment, we kindly request that you give our office 24-hour notice.
If we do not receive 24-hour notice, there will be a cancellation fee billed to the patient or responsible party. This fee will be waived with the first occurrence. Thereafter, the cancellation fees are as follows: $35 for a regular appointment and $75 for all surgery, filler, Botox, or laser appointments.
Please note: Patients who continually miss their appointments without giving proper notice to our office staff will be discharged from the practice after the third violation.
- Gift Certificates MUST be present at the time of service.
- Gift Certificates are nonrefundable and nontransferable.
- Gift Certificates can only be used for our aesthetician’s services.
- Martha E. Stewart, MD, LLC is not responsible for lost or stolen Gift Certificates.
- Gift Certificates are valid for one year from the date of purchase.
American Academy of Dermatology
The American Academy of Dermatology provides expert insight into the care and treatment of skin, hair, and nails.
American Society of Dermatologic Surgery
The American Society of Dermatologic Surgery is the largest specialty organization in the United States exclusively representing dermatologic surgeons.
Skin Cancer Foundation
The Skin Cancer Foundation is the only international organization devoted solely to the education, prevention, early detection, and prompt treatment of skin cancer.
View Our Health Library
Find more information on various dermatology conditions and cosmetic procedures.
Download Our App Here
Access our Health Library from your mobile device. Helpful resources such as health references, videos, self care tools and more are just a click away.
Have a Question?
We request that any medical correspondence, including prescription refill requests, be through our patient portal. The portal keeps your personal health information secure and private. You can easily access your portal at the top of our website under “Patient Portal.” Use your login information that you received at your visit. If you do not have this information, please contact our office at 985-727-7701 and one of our staff members can assist you with your login. If you are a new patient, you will be given access and login information at your office visit.