Advanced Dermatology - Portland Oregon

 

Forms

New patients:  Read the welcome letter and fill out the medical history, financial policy, acknowledgement and consent, and patient registration forms prior to your upcoming dermatology appointment.
 
Referrals:  If your insurance carrier requires a referral to see a dermatologist, please contact your primary care provider to initiate a referral prior to your appointment.
 
Transfer of Medical Care:  If you would like to transfer your care from a previous physician to Advanced Dermatology of Oregon, please fill out the medical information release form and fax it to your previous physician.
 
For Referring Physicians:  If you would like to refer a patient to Advanced Dermatology of Oregon, please fill out the physician referral form and fax it to 503-692-8643.


1.  Welcome Letter

2.  Medical History

3.  Financial Policy

4.  Medical Release of Information

5.  Patient Registration Form

6.  Physician Referral Form

7. Cosmetic Interest Questionnaire

8. Acknowledgement and Consent

9. Notice of Provider Privacy Practices

 


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Maeran Chung Landers, MD PhD
Advanced Dermatology of Oregon
19255 SW 65th Ave Suite 260
Tualatin OR 97062
503-692-9525 (tele)

© 2006 Advanced Dermatology of Oregon