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Patient Forms
Like most medical offices, we have a few forms that need to be filled out. To make it easier, we’ve bundled everything into one downloadable packet.
Forms Include
- New Patient Information Form
- Consent for Treatment
- Medical History
- HIPAA Privacy Notice
- Authorization to Release Medical Records
- Office Financial Policy
Insurance Providers
Lady Lake & Leesburg Dermatology & Mohs Surgery is contracted with a large variety of insurance plans to best serve you. To get the most accurate and up-to-date information, contact your insurance company for details about your plan and information regarding in-network providers and referrals.
Please call our billing office at (352)633-7930 or the office location you plan to visit if you need additional help or don’t see your plan below.
Accepted Insurances
Not Accepted
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Make Your Online Payment
This form is used to initiate your payment request. Please do not enter any sensitive payment information, as this form is not encrypted.
Once submitted, a member of our team will contact you by phone to securely collect your payment details. Please complete all required fields below and allow up to 72 hours for processing.
Questions & Answers
What types of skin conditions does Leesburg Dermatology & Mohs Surgery treat?
We treat a wide range of skin conditions, from chronic issues like psoriasis and eczema to concerns about moles and skin cancer.
What makes Leesburg Dermatology & Mohs Surgery a reliable choice?
Our clinic specializes in comprehensive skincare and Mohs surgery, which is recognized as the safest and most effective treatment for skin cancer.
How is the clinic staff selected?
Every staff member is carefully chosen not only for their strong qualifications but also for their genuine dedication to patient care and compassion.
Who founded Leesburg Dermatology & Mohs Surgery?
Dr. Johnny Gurgen founded the clinic. He’s a recognized leader in dermatology, both in Leesburg and globally.
What are Dr. Gurgen’s credentials and achievements?
Dr. Gurgen has been published in prestigious journals like the Journal of the American Academy of Dermatology and has spoken at major events such as the American Academy of Dermatology conferences.
How does Dr. Gurgen give back to the community?
He volunteers for initiatives like Melanoma Monday skin exams and educates local high school students during events like the Great American Teach-In.
What can patients expect from the staff at Leesburg Dermatology & Mohs Surgery?
Our team consists of top graduates who share Dr. Gurgen’s philosophy of personalized, attentive care. We aim to provide outstanding service for every skin concern.
How often should I see a dermatologist?
It’s recommended to have a full-body skin examination annually. However, if you notice any new or changing skin lesions, persistent rashes, or other concerns, schedule an appointment promptly.
How can I tell if a mole or spot is concerning?
Use the ABCDEs: Asymmetry, Border irregularity, Color variation, Diameter over 6mm, and Evolving shape or size. Any of these signs warrant a dermatologist’s evaluation.
What is Mohs surgery?
Mohs surgery is a precise surgical technique used to treat skin cancer. It involves removing cancerous tissue layer by layer while preserving as much healthy tissue as possible.
How can I prevent premature skin aging?
Protect your skin from sun exposure by using broad-spectrum sunscreen daily, avoid smoking, maintain a healthy diet, and use skincare products containing antioxidants and retinoids.
What are the risk factors for skin cancer?
Risk factors include fair skin, a history of sunburns, excessive UV exposure (from the sun or tanning beds), a family history of skin cancer, and having many or atypical moles.
