Patient Resources/ Forms

To better serve our patients we are currently in the process of converting to an electronic medical record system.  We are asking that all patients, both new and existing, update their paperwork to ensure that we have the most current and accurate data.  You may either print and complete the Patient Packet at home to save time, or you can come in 15-20 minutes before your appointment to fill out the paperwork.

Individual Forms
Patient Registration (PDF)
HIPAA Form (PDF)
Health History (PDF)
Medical Records Release (PDF)

Insurance
We bill insurance as a courtesy on your behalf with payment due according to the provider contract.  We cannot provide information about individual policy benefits.  We are contracted with several insurance carriers, but may not be contracted with your individual plan or group.  You will need to contact your carrier directly to determine if we are contracted with them and on your Preferred Provider network. Insurance claims are submitted with the understanding that you are responsible for any non-covered services, copayments, and deductibles.

A current insurance card must be presented prior to services being rendered.  Any office visit or surgical copay is due at the time of service.

Cosmetic procedures are not covered by insurance plans.  Please be prepared to pay at the time of service.  Deschutes Dermatology Center will never bill insurance for any cosmetic procedure or skin care product.

CareCredit

We’re pleased to offer our patients the CareCredit® card for surgical procedures.CareCredit lets you begin your treatments immediately — then pay for it over time with convenient monthly payments that fit easily into your budget. Now you don’t have to save up for years to finally get the treatments you’ve always wanted.

Click Here to apply

Late Policy
We have a 10 minute late policy.  When a patient is more than 10 minutes late, we reserve the right to shorten or reschedule the appointment, if needed, so as not to inconvenience other patients.

Cancellation Policy
When rescheduling or cancelling appointments please provide us with at least 24 hours notice.  This courtesy allows our office to schedule another patient in your place.  If an emergency arises, please give us as much notice as possible.  Failure to show up for a scheduled appointment without a cancellation phone call will be subject to a fee.

Missed office visit: $25
There is a $25.00 fee for missed office visits without 24 hour notification.

Prescription Refills
Please contact your pharmacy to request your prescription refill, even if the label on the medication container says there are no remaining refills.  If our providers feel it is necessary or if you have not been seen within the last year, your pharmacy will be notified that you need to schedule a refill appointment.