Patient Forms

Below is the Medical History form you’ll need to complete on your first visit. You can expedite matters by downloading this form, completing it at home and handing it to our staff when you arrive for your initial visit to our office.

Patient Forms – PDF

If you are looking for a highly trained and experienced dermatologist in Brooklyn, you have come to the right place. At our practice, you will receive the highest quality dermalogical care. Our office uses the latest state-of-the-art equipment and cutting edge technology and we uphold the strictest sterilization techniques. We know that many people may feel anxious about coming to the dermatologist, so it is our goal to make your visit with us as pain and anxiety free as possible. We view it as our mission to educate our patients about all of their health care options and to help guide them to choose a treatment plan that is most suitable and appropriate for their needs.

Dr. Eliot Y. Ghatan specializes in dermatology and aesthetic surgery. His office is located at 1226 Ocean Parkway, Brooklyn, New York 11230. Dr. Ghatan is easy reachable from Breezy Point, Bronx, Brooklyn, Connecticut, Far Rockaway, Howard Beach, Long Island, Manhattan, New Jersey, Queens, Ridgewood, Rockaway Park, and Staten Island.

Insurances We Accept

We participate in or accept most major insurance plans, which are listed below. If your plan is not listed please call us and ask because we may accept it.

  • 1199 NATIONAL BENEFIT
  • AETNA
  • AFFINITY
  • AMERIGROUP (EMPIRE BLUE CROSS)
  • CARECONNECT
  • CIGNA
  • ELDERPLAN
  • EMBLEMHEALTH/GHI
  • EMPIRE (BLUE CROSS)
  • EMPIRE PLAN
  • FIDELIS CARE
  • GHI
  • HEALTHCARE PARTNERS
  • HEALTH FIRST
  • HEALTH PLUS
  • HIP
  • MAGNACARE
  • MEDICARE
  • METROPLUS
  • OSCAR
  • OXFORD
  • TRICARE
  • UNITED HEALTHCARE
  • US FAMILY HEALTH

If you are eligible for Medicaid, you may choose and or switch between different plans approved by Medicaid office. It is extremely easy to switch insurance providers. You can do it yourself and it just takes a few minutes of your time.

You can call Medicaid office at (800) 252-8263, or visit them online at www.nymedicaidchoice.com

Our office currently accepts the following Medicaid managed care plans:
Empire Blue Cross (Amerigroup), Healthfirst, Fidelis, Metroplus, and Affinity Health Plan.

New Patients

Your first visit to our office establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important information, like your medical history, and give you time to get to know Dr. Ghatan. To understand what to expect for your first visit to our practice, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more.

What to Expect at Your First Visit
On your first visit, Dr. Ghatan will review your medical history and evaluate your condition. He will be more than happy to answer any questions you might have.

Mission Statement
Our office’s mission is to work together with you to realize a shared vision of uncompromising excellence in dermatology.

To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earning the trust and respect of our patients and the community.
  • Meeting and exceeding our patients’ expectations.
  • Ensuring a compassionate, professional environment.
  • Providing state-of-the-art procedures, materials and treatment choices to our patients.

INSURANCE RESPONSIBILITY

As you are aware, medicine has been in a state of change for the past few years. The results have led to employers choosing health plans that have transferred significant costs to employees. These Include rising deductibles, co-payments, and coinsurance. These transferred costs to patients are responsible for a portion or in some cases the entirety of certain charges.

We have been very proactive in participating in certain plans in the hope that we can alleviate some of those costs for you. Participating in these plans becomes cost prohibitive if we need to bill both you and the insurance company for each visit. In order for us to be able to keep these plans and preserve our quality of care, we are eliminating patient billing. This standard has been established in the vast majority of practices in the United States. We now require every patient to leave on file a valid and current credit card with the signature on file with us. Eliot Y. Ghatan, MD will be authorized to bill the card for ‘patient responsibility’ as it appears on your explanation of benefits that you receive from your insurance after each office visit. Will give you a courtesy call before making any charges to the card if needed.

Our staff continues to work aggressively to ensure that your health plan covers their responsibility as well. We simply can no longer allow receivables as the business model of medicine has changed and does not allow for payment delays. ALL payments including co-payments, coinsurances are due at the time of visit. You will be asked to make payment when entering the office prior to being seen. If any over-payment is ever made based on fulfilling your deductible, we will make all necessary adjustments and refund you. Insurance plan may restrict you to specific diagnostic facilities and /or hospitals. Please become familiar with the provisions of your plan as we do not have access to that information. The front staff will provide you with a form to fill out at the time of your next visit with a credit card authorization. Please have a current credit card available when you arrive.

HIPAA Form – PDF

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

Payment Options

We accept Mastercard, Visa, American Express and Discover credit cards as well as cash. We accept many insurance plans . Please click here to find out if we accept your plan.