Call To Schedule An Appointment!
909-796-0224 (Loma Linda)
951-845-6500 (Beaumont)

Patient Resources and Information

New Patient Information

New Patient Registration Form

New Patient Registration Form
This form should be printed and filled out prior to your first visit to the office.

Existing Patient With Changes?

Patient Registration Form
This form should be printed and filled out prior to your visit to the office if you are an established patient with a change in address or insurance coverage.

Mohs Surgery Information

Mohs Micrographic Surgery Information Sheet
This form provides all information regarding the Mohs procedure including a description of the technique and instructions before and after surgery.

Exposure Form

Exposure Questionnaire
This form should be printed and filled out prior to your visit to Dr. Jacob.

We accept most major medical insurance plans

  • Aetna US Healthcare PPO
  • Alliance PPO
  • Beaver Medical Group - with authorization
  • Blue Cross
  • Blue Cross Blue Shield
  • BRMS
  • Capital Care
  • Capp Care
  • CareFirst/BlueChoice
  • Carpenters Health and Welfare
  • CCS
  • Champus
  • Cigna PPO
  • Coventry
  • Firemans Fund
  • First Health
  • GEHA
  • Healthkeepers
  • HealthNet
  • Humana
  • Mail Handlers
  • Mamsi
  • Medicare
  • Multiplan
  • Optimum Choice
  • Pacificare
  • Plan Handlers
  • Principal Life
  • ProMed Healthcare (Prospect)
  • Prudential
  • Risk Management
  • Southwest Administrators
  • State Farm Insurance
  • Travelers
  • Tri West
  • Tricare
  • United Healthcare
  • UPS

This may not be a comprehensive list - if you have medical insurance other than what is listed above, please call Loma Linda Dermatology and we'd be happy to let you know if we can accept your plan. Please remember to bring all your insurance information with you to your appointment. Please be prepared to make any co-payment specified by your insurer. If you do not see your insurance provider listed, please contact our office as our list changes frequently.

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Medical Society Affiliations

Kenneth Dale Macknet Jr., MD and Cathy Macknet Kasner, MD

American Academy of Dermatology

American Academy of Dermatology The American Academy of Dermatology is the largest, most influential and most representative of all dermatologic associations. With a membership of over 16,000, it represents virtually all practicing dermatologists in the United States. The Academy is committed to excellence in patient care, medical and public education, research, professionalism and member service and support. It also plays a major role in formulating socioeconomic policies that can influence the quality of dermatologic care. For more information, please visit their website:

American Society for Dermatologic Surgery

American Society for Dermatologic Surgery Founded in 1970, the American Society for Dermatologic Surgery (ASDS) and its nearly 4,700 members are at the forefront of the development of safe, in-office procedures that are saving lives by diagnosing and treating potentially deadly skin cancers earlier and more effectively.

Today, ASDS members are recognized within the medical community as leaders in the field of dermatology and as advocates for patient safety. ASDS members not only lead the field of specialists in the treatment of skin cancer, but also are the premier specialty group trained to treat skin and soft tissue in both medically necessary and cosmetic surgical and non-surgical methods. For more information, please visit their website:

American Society of Mohs Surgery

American Society of Mohs Surgery The American Society of Mohs Surgery is a professional medical society consisting of over 850 member physicians and technicians. The primary purposes of the organization are to provide advocacy for Mohs surgeons from a variety of Mohs training backgrounds, to support our members in the area of practice resources, and to offer high-quality educational programs in Mohs surgery to the dermatologic community.

While acknowledging the value of all forms of Mohs training, including formal Mohs fellowships, the ASMS asserts that any surgically-oriented Board-certified dermatologist has the basic dermatopathology, cutaneous oncology, and complex closure abilities to effectively perform the Mohs procedure in his or her office-based practice. The ASMS is an inclusive educational organization with membership open to any dermatologist with an interest in the Mohs technique. Board certification in dermatology is required for Fellow and Affiliate dermatologist members. Additional requirements apply to Fellow member applicants. For more information, please visit their website:

American College of Mohs Micrographic Surgery and Cutaneous Oncology

American College of Mohs Micrographic Surgery and Cutaneous Oncology The American College of Mohs Surgery, referred to as ACMS or the Mohs College, was established in 1967. It was named after Frederic Mohs, MD, who developed the procedure and served as the first president of the College.

From its inception, the College promotes and continues to set the highest standards of patient care relating to Mohs Micrographic Surgery through its fellowship training process.

There have been many advancements in the procedure over the years and the College has grown to over 900 members, all of whom have received advanced, fellowship training in Mohs surgery, pathology and reconstructive surgery. For more information, please visit their website:

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Dermatology and skin healthcare links of interest.

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