Please print & fill out the applicable forms, and bring along to your appointment. Thank you.
Please only fill out the following if insurance coverage is Medical Assistance or Medicare. The release form is optional, only if you'd like your records released from our office.
Your First AppointmentArrive A Few Minutes Early
On your appointment day, we ask that you please arrive a few minutes early to complete new patient paperwork.Upon Arrival
As you enter the waiting room you will find fresh-cut flowers, Georgia O’Keefe artwork, and a warm & inviting reception staff.What To Bring
Your insurance card, identification card, and a list of medications you are currently taking.A Note About Wait-Times
Dr. Crutchfield is dedicated to providing the highest level of care to each patient. For this reason, you may experience a wait-time on your appointment day.
We offer an abundance of reading materials, complimentary Wi-Fi (we were the 1st in the nation to provide WiFi in our waiting room!), and an informational dermatologic video in our reception area. If you have a time-sensitive schedule, please be sure to call ahead to check the daily clinic scheduling flow.
As a service to our patients, we provide courtesy appointment reminders and other important communication through a per-recorded message, text message, or email. By providing us your telephone numbers and email address, you consent to receiving such communication from your health care provider. You may opt out of receiving some of all of these communications by notifying the clinic in writing at any time or by replying "Stop" to the automated system.Questions? Please Call
Should you have any questions prior to your appointment date, please feel free to contact our office at 651-209-3600. We look forward to seeing you soon!
Appointment for a minor
We ask that all patients that are minors bring a parent or legal guardian with them when they come in for their first doctor’s appointment. If the parent or legal guardian would like the minor to be seen unattended for any additional appointments, we have a consent form that the parent or legal guardian can sign.
Minor Children: The parent or guardian bringing the child to the office for their visit is responsible for payment independent of what a divorce doctrine may state. Reimbursement must be made between divorced parents. We will not intervene.
Dr. Crutchfield is a member or graduate of these prestigious organizations.
Demonstrating his education, experience, and commitment to providing patients with the highest quality medical & cosmetic dermatologic care.
When choosing your physician, demand nothing less. Remember..... "Quality Matters"
1185 Town Centre Drive Suite 101 Eagan, MN 55123
Phone: (651) 209-3600 Fax: (651) 209-3601
© Crutchfield Dermatology
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