For Patients

Office Policies

At Mira Visa Surgical Dermatology, we value your time. We attempt to avoid overbooking our schedule to ensure that we run on time and provide the best experience for your visit. Should you be unable to keep your appointment, please let us know at least 48 hours in advance. Failure to provide advanced notice of cancellation may result in a $50 fee for clinic visits and $150 fee for surgical and procedural visits. These fees are not reimbursable by your insurance company. If you are late to your appointment, we will attempt to accommodate you but may request that you reschedule.

Insurance Accepted

  • Aetna
  • Beech Street
  • Blue Cross Blue Shield
  • Care Improvement Plus
  • Care N Care
  • Cigna
  • Coventry
  • Galaxy Healthcare
  • HealthSmart
  • HMO Blue Texas
  • Humana
  • Independent Medical Systems
  • Integrated Health Plan
  • Medicare
  • The Miers Group 
  • Multiplan PPO
  • National Preferred Provider Network
  • Nexcaliber
  • Oscar Insurance Company of Texas
  • Prime Health Services
  • Private Healthcare Systems
  • Provider Select PPO
  • Scott and White
  • Three Rivers Provider Network
  • Texas Bluebonnet
  • Tricare
  • United Healthcare
  • USA Managed Care Organization
  • Wellcare
  • XL Healthcare Improvement Plus
  • Please check with your insurance company prior to your visit to be sure we accept your plan. If we do not participate with your health insurance, we are happy to see you but please be aware that you will be responsible for the full amount of the visit and any related services. If required by your insurance company, please obtain a referral from your referring provider prior to scheduling your visit.

    Preparing For Your Visit

    What to Bring
    • Completed patient forms
    • Pharmacy information
    • Insurance Card(s)
    • Driver’s License
    • List of medications and any relevant medical records

    Please consider arriving 10 minutes early for your appointment or 30 minutes early if you need to fill out paperwork.Combined Patient Forms, Updated 11-7-2019

    Thank you and we look forward to serving you!

    Click here to download PDF Patient Forms

    The forms may be completed on your computer using the Fill and Sign function under the Tools tab of Adobe Acrobat.

    Contact Us

    Our Location:
    7000 Bryant Irvin Rd, Ste 100
    Fort Worth, TX 76132

    Tel: 817.882.6338
    FAX: 817.759.9808

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