Patient Forms

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          • Financial policy
          • Credit Card on file
          • Consent to treat minors
          • HIPAA form
          • Authorization to release medical records to other physicians
          • Authorization to request medical records from other physicians

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We recommend that prior to scheduling an appointment with Dr. Martinez-Diaz, that you call your insurance provider and verify that we are in network for your insurance. For patients that we are out of network, a self pay rate will be provided upon scheduling an appointment. Please read more about our financial policy.

  • Aetna
  • Beech
  • Blue Cross Blue Shield PPO, Blue Choice POS, Blue Advantage, Blue Choice Select
  • Cigna
  • Cofinity PPO
  • First Health
  • Galaxy MCI
  • HFN
  • Humana Choice Care, Humana Commercial EPO/POS
  • Multiplan
  • Private Healthcare Systems (PHCS) – Savility PPO, POS
  • Preferred Plan
  • United
  • United Medicare Advantage


M D Aesthetics and Dermatology, LLC