Molewatch, Midwest Dermatology Clinic, P.C.

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Skin Cancer

Molewatch

Molewatch is a free service of Midwest Dermatology Clinic. If you have a suspicious mole, we invite you to see a Midwest Dermatology Clinic physician for an examination, free of charge.

Please complete the information below and fill out our Molewatch Map. You will be contacted for an appointment at the office most convenient to you.

Molewatch is an initial screening and cannot be substituted for an annual skin examination.

Note: the free Molewatch examination includes only the examination of moles. Any additional diagnostic testing or treatment will be provided at the regular charge. Patients with additional dermatologic problems will be charged for that portion of their visit. Molewatch examinations are intended to assist in diagnosis and medical care of untreated skin cancers and are not a substitute for routine follow-up care.

MOLEWATCH IS OFFERED TO RESIDENTS OF NEBRASKA AND SURROUNDING STATES ONLY.

Contact Information (* denotes required field)

Name:	*
Address:	*

City:	*
State:	*
Zip code:	*

Daytime phone:	*
Cell phone:
Email address:	*

Date of birth:	*	/ / (mm/dd/yyyy)

Location Information (select one)

Office location:	Omaha - Midtown
	Omaha - Oakview
	Omaha - Lakeside
	Bellevue
	Norfolk (temporarily unavailable at this location)

	*A completed Molewatch Map is required at your visit.* Click here to print out your Molewatch Map and track your suspicious moles. Don't forget to bring this to your Molewatch exam.

Optional Information (not required for Molewatch)

Comments:

	All information submitted to Midwest Dermatology Clinic, P.C. will be held in the strictest confidence. The information provided above will be used for internal business only and will not be sold or targeted for marketing purposes. Click here to review our Molewatch policy.