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Patient Forms

WELCOME TO NORTH PACIFIC DERMATOLOGY

Dear Patient,

Thank you for choosing North Pacific Dermatology for your dermatologic needs. We look forward to getting to know you! Here is some information we hope will be helpful as you prepare for your first appointment with us.

WHAT TO BRING TO YOUR APPOINTMENT

  • Completed Registraton Forms (If you do not have your completed registration forms at the time of your appointment your appointment will be rescheduled. Also, please do not mail your forms back.)
  • List of prescriptions, over the counter medications, and supplements
  • Insurance Cards

MINOR PATIENTS

Because treatment cannot be provided without consent, a minor must be accompanied by a parent or legal guardian. If you are a legal guardian, you will be required to show legal documents that clearly state your guardianship status. Because you are unable to determine financial responsibilities of divorced parents, we will look to the parent accompanying the minor for payment.

MISSED APPOINTMENTS

Please be aware there is a high demand for dermatology appointments and a cost to the practice for "no shows." Appointments not cancelled within 24 hours are considered "missed appointments." A $50 charge will apply for cosmetic missed appointments. If you should miss three appointments without the required notice, you may be dismissed from the practice. Please see enclosed Cancellation Policy.

PRIVATE PAYMENT

Payment will be collected at the time of service. Upon request, you will be given a written estimate for any recommended treatment beyond the initial examination. If you have any question or concern about payment or fees, we hope that you will feel comfortable enough to discuss it with us.

INSURANCE

Payment will be collected at the time of service. Upon request, you will be given a written estimate for any recommended treatment beyond the initial examination. If you have any question or concern about payment or fees, we hope that you will feel comfortable enough to discuss it with us.

RETURNED CHECK FEE

There will be a $25 fee imposed for checks returned for non-payment of funds.

REQUEST FOR MEDICAL RECORDS

You may contact our office during regular business hours for direction on how to request your medical records. Please allow 72 hours for your records to be processed and ready.