Patient Info

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Download Forms

We are looking forward to your visit. Please print and complete the following new patient forms.

New Patient Forms – (Adults)

New Patient Forms – (Minors)

Authorization to Disclose Protected Health Information

Notice of Privacy Practices

Medical Records Release

Telehealth Consent


Please click a question to view the answer to one of our frequently asked questions.

What are your office hours?

Our office hours are as follows:

  • Mon, Wed | 7:30 AM – 4:00 PM
  • Tues | 7:30 AM – 4:30 PM
  • Thurs | 8:30 AM – 4:30 PM
  • Fri | 8:30 AM – 4:00 PM 

Please contact us to schedule an appointment.

What is the Patient Portal?

The patient portal allows secure communication between you and Novi Dermatology and allows you to:

  • View and update your health information
  • Update your preferred pharmacy information
  • Send Novi Dermatology a secure message

Login to the Patient Portal >

How can I pay my bill?
  • Online: Credit card payments are accepted online. Follow the instructions under “Pay a Bill” at the top of this page. You will be directed to our secure online payment website. If using an HSA card, be sure you have the correct billing zip code.  You can also log onto your Patient Portal to make a Credit Card Payment.
  • Phone: Call us at 248-946-4787 to make a credit card payment.
  • In Person: Visit us at Novi Dermatology (44000 West 12 Mile Rd, Suite 103, Novi, MI 48377) to make a payment in person (cash, check, or credit card).
  • Mail: Please be sure to enclose your statement stub (top portion of your statement) and mail check or credit card payment to the payment address below. DO NOT MAIL CASH.

Payment Address:

Novi Dermatology PLLC
PO BOX 775453
CHICAGO, IL 60677-5453

If you have billing questions, please call us at 248-946-4787.

How much is a late payment or returned check fee?

We appreciate timely payment and provide a grace period of 60 days from the first statement date.

Payments not received after 60 days from the statement date will incur a late fee of $35.

A fee of $35 will be assessed for each returned check.

What is your no-show fee?
The no-show fee is $50 and applies to anyone who misses an appointment or does not cancel/reschedule the appointment with at least a 24-hour notice.
What types of insurance do you accept?

We accept the following insurance:

  • AARP
  • Aetna
  • Blue Care Network: PCP referral is required
  • Blue Care Network Medicare Advantage
  • Blue Cross Blue Shield (BCBS)
  • Cigna
  • Cofinity Network
  • Health Alliance Plan (HAP)
  • Humana Medicare Advantage
  • Medicare
  • Multiplan / PHCS network
  • Priority Health
  • Tricare Prime: PCP referral is required
  • Tricare East: Tricare Select, Reserve Select, Retired Reserve
  • Tricare for Life Medicare Supplement
  • United Health Care

Please call us at 248-946-4787 for additional information. Some insurances (other than noted above) will require a referral from your Primary Care Physician (PCP).

Still have a question? Please contact us. Our staff is here to provide answers to any questions you may have.


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Call 248-946-4787 or submit a request via chat and we'll contact you with available openings. 

Novi Dermatology Logo

Novi Dermatology
44000 W. 12 Mile Road
# 103
Novi, MI 48377
Directions >

Phone: 248-946-4787
Fax: 248-716-5956

Map of Novi Dermatology Location in Novi, MI

Office Hours
Mon, Wed | 7:30 AM – 4:00 PM
Tues | 7:30 AM – 4:30 PM
Thurs | 8:30 AM – 4:30 PM
Fri | 8:30 AM – 4:00 PM