Forms & Insurance

Patient Forms

Please download, read, and fill out your patient forms prior to your visit. Click the links below to download the forms and other documents about our policies.

  1. Patient forms and financial policy
  2. Notice of privacy practices
  3. The physician-patient relationship
  4. Patient rights and responsibilities


The team at Dermatology & Laser Center of Chapel Hill (DLC) participates with:

  • Blue Cross and Blue Shield of North Carolina (BCBS) plans *see list below
  • Cigna Healthcare
  • Medicare
  • United Healthcare (effective 1/24/18)

Here is a detailed list of the BCBS plans that we do and do not participate with.

We do accept:

  • Blue Advantage
  • Blue Care
  • Blue Options
  • Blue Select
  • Classic Blue
  • The North Carolina State Health Plan

We do not accept:

  • Blue Value
  • Blue Local

If you have other insurance that we do not accept, please make sure to get a receipt so that you may file a claim. Please note that insurance plans will most likely not cover cosmetic treatments.


If you have any questions about insurance or your bill, please contact DLC:

Phone: 919-942-2922



DLC is a certified Coolsculpting Complete Practice, which means we have the most updated technology. This means we can offer better results and a more comfortable experience in half the time! Plus we have 2 machines so we can treat 2 areas at once. #cool…

- October 18, 2018