banner image

Provider Referral

Patient Referral

Dear providers:

Carolina’s Dermatology and Plastic Surgery is committed to providing the best care for your patients’ needs of Dermatology, Mohs Surgery, and Plastic Surgery.

If your patient needs to be seen urgently, please note that in the referral form. We will see them within 4 business days if not sooner.


Please see below an updated list of insurance plans that we accept.

Accepted Insurance Plans
  • Self Pay  
  • Aetna
  • Aetna Medicare
  • Allied
  • Blue Choice (ZCC – authorization required)
  • Blue Cross Blue Sheild PPO
  • Blue Cross Federal
  • Blue Cross State (PEBA)
  • Champ VA
  • Cigna
  • Cigna Medicare Advantage
  • Department Of Energy/Labor (Surgeries)
  • First Health
  • Freedom Life Ins CO
  • Geha
  • Healthsmart
  • Medcost
  • Medicare
  • Multi Plan
  • Pai
  • PHCS
  • Tricare East (Prime – referral required)
  • UMR
  • UHC Medicare Advantage (ALL PLANS)
  • UHC (all savers, golden rule, oxford, etc…)
  • VA – VACCN – referral required
  • Christian Brothers
  • Medishare
  • Healthgram
  • CWI Benefits
  • Aither (PHCS or Multiplan)
NOT Accepted Insurance Plans
  • Humana Medicare
  • Molina
  • Select Health
  • Wellcare
  • VIP
  • First Choice
  • Workers Comp
  • Prisma Financial Assistance Program
  • NO International Plans
  • Absolute Total Care/Allwell

To refer your patient to one of our offices, simply fill out our online patient referral form.

For patients from any facility (nursing, home, assisted living, etc)

If the patient, for any reason, can not consent to any treatment by our practice, we request that the patient’s responsible party (such as relatives) fill out and sign this form before the visit.

Request Appointment

*This is a request form, not a guaranteed appointment. Upon receiving this completed form, we will contact you to confirm your actual appointment. If you need immediate assistance, please give us a call.