Forms of payment

Accepted forms of payment at Dermatology Specialists of West Georgia, P.C. include cash, credit cards (Visa, MasterCard, American Express, and Discover), debit cards, and personal checks. Payment is due at the time of service for any copayments, coinsurance, or deductibles. We also accept Health Savings Account (HSA) and Flexible Spending Account (FSA) cards for eligible services. For convenience, payment arrangements can be discussed with our billing department in advance of your appointment. Please note that returned checks may incur an additional processing fee.

Authorization to Keep Credit Card on File

I hereby authorize Dermatology Specialists of West Georgia, P.C. (d/b/a Carroll Cosmetic Club to keep my debit or credit card information on file for payment and to charge my card on file for any balance due following receipt of any applicable insurance payments in connection with healthcare services rendered. Following each service, Dermatology Specialists of West Georgia, P.C. will submit any relevant insurance claim on my behalf. Upon receiving notice of adjudication of such insurance claim, Dermatology Specialists of West Georgia, P.C. may charge my card on file for the amount of patient responsibility, according to my insurance company. I understand that Dermatology Specialists of West Georgia, P.C. will not be required to provide any further notice to me before charging my card. The maximum amount that Dermatology Specialists of West Georgia, P.C. will charge my card under this authorization is $500.00 per month. I understand that I will be responsible for any remaining amount due after Dermatology Specialists of West Georgia, P.C. charges my card, or if they cannot charge my card for any reason. I acknowledge that the initiation of all such entries to make payments on the patient account must comply with the provisions of U.S. law and any applicable state laws. These entries may be made to my debit, credit card, or bank account as applicable, periodically to pay amounts owed by me on the patient account. I also agree to notify Dermatology Specialists of West Georgia, P.C. if my debit or credit card information changes for any reason. This authorization shall remain in effect until I communicate my intention to cancel this authorization once my account is settled by calling the business office at (770) 838-9333.

Cancellations + No Shows

If you must cancel or reschedule any appointment, please provide us with a 24 hour notice. All appointments that are no showed, cancelled or rescheduled with less than a 24 hour notice will result in a charge of $100.  

Late Policy

Out of respect for other guests and our time, we have a 15 minute late policy. If a guest is 15 minutes late or more, they may be asked to shorten their service time, or be asked to reschedule their appointment. If rescheduling is required, there will be a charge for $100 for the missed service. 

Authorization of Payment and Release of Information

I request payment of authorized insurance benefits be paid to Dermatology Specialists of West Georgia. P.C. (d/b/a Newnan Dermatology) and authorize release of medical information to determine payable benefits for services rendered.

Returned Checks

There is a $ 55.00 fee for all returned checks.