Download Pharmacy Policy - Bergen Dermatology

Dear Valued Patient:
We are currently using a new Pharmacy Delivery Service that will make your experience with our office and obtaining
your prescriptions stress-free and simple. The name of the Pharmacy is Bergen Medical Pharmacy located in Paramus,
NJ. Once we send your prescription directly to them on the date of your visit, they will contact you and set up a delivery
date for your medication so that you can have it delivered right to your doorstep. The pharmacy will also sign you up for
any available savings cards for brand name medications. Dr. Boakye has no affiliations or stock in this establishment.
We would like your permission to send all of your prescriptions to Bergen Medical Pharmacy. Medications that require
prior authorization will be sent to Bergen Medical Pharmacy for we do not do prior authorizations at this office. Please
sign below, allowing us to do so. As always, your feedback is much appreciated.
In order to accommodate the needs and request of my patients, I have enrolled in numerous insurance plans. While I am
pleased to be able to provide this service, it is extremely difficult for my staff and me to keep up with all of the specific
requirements of each plan, WITHOUT YOUR FULL COOPERATION. Please understand that each plan has different
stipulations such as referrals, authorizations, lab work, etc. It is very important that you, the patient, come to our office
with all of the required documentation and be fully aware of how your plan works prior to the time of your scheduled
appointment.
Sincerely,
Bergen Dermatology, LLC
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Patient Name
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Patient Signature
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Date
140 Sylvan Ave, Suite 305 | Englewood Cliffs, NJ 07632 | 201.567.SKIN | 201.585.1007