It’s our commitment to provide you the most modern and effective dermatology treatments available. To help us accomplish this mission, Dermatology Alliance Keller, Coppell, and Roanoke use a paperless health record system.
This helps us provide you with:
- Shorter wait times
- High data accuracy
- Quick, convenient access to your health records
We created this section to give you easy electronic access to all paperwork you may need to complete before your appointment. You will find our high standards for patient confidentiality and a list of all types of insurance we accept.
If you do not see your insurance provider listed, we unfortunately cannot accept your insurance. You can still use our services, but full payment for all services rendered will be your responsibility when you visit us for your appointment.
If you have a question about any of these forms or how they work, please contact us online or call
The Keller Office: 817-431-6555
The Coppell Office: 469-312-7302
The Roanoke Office: 682-237-2271
Forms available:
- Registration Forms – The standard forms you sign to receive services
- Accepted Insurance – A list of all insurance providers we accept
- Patient Privacy Notice – Discusses how we will use your medical information and how you can access it
- General Patient Authorization – Authorizes Dermatology Alliance-Coppell’s physicians to provide you with services
- Minor Consent Form – Gives us permission to treat your child/minor
