forms
At the Center for Excellence in Dermatology, we understand the need for information about health care and insurance coverage. The following forms will help allow us to provide you with the best care possible.
Please complete the forms in the appropriate packet and bring them to the office at your scheduled appointment time.
How to Download Files
The files below are PDF documents.
When you click the blue button, the document will open in a new window.
Click the download arrow in the upper right corner to download the file, as illustrated here.
Established Patients
The files below are PDF documents.
When you click the blue button, the document will open in a new window.
Click the download arrow in the upper right corner to download the file, as illustrated here.
If you have been seen in the last 3 years, download:
If you have NOT been seen in the last 3 years, download:
There are 3 ways to securely deliver this information to the office once the forms are completed. Unfortunately, email is not secure.
1. Call the office and a receptionist will take the information over the phone and create the chart. This is the fastest method. You can then mail the forms to the office for review and scanning into your chart.
2. Alternately you can mail in the form to:
Center for Excellence in Dermatology
Attention: Telemedicine
8901 W Gage Blvd
Kennewick, WA 99336
This will take a little more time, but it’s the easiest method.
3. Have a friend, relative, or personally, drop off the forms with the person monitoring the front door of the building. They are there from 8 am to 4 pm. No need to enter the building. Also, it is a quick and easy method of delivery. When the chart is updated, a medical assistant will call you 10 minutes before your appointment to review the information for completeness and answer any questions. An assistant will call before the telemedicine appointment and check your connection. They will help you with any technical problems that you are having and answer any questions you have.
Additional Forms
If you are a new patient, download: