Forms

Forms

New Patient Forms

Save time! If you are a new patient with an upcoming appointment and would like to complete the registration process prior to your arrival at our office, download our new patient forms below:

Eastside Dermatology Patient Forms

Lake Washington Dermatology Release of Medical Records

Lake Washington Dermatology Minor Patient Form

North Pacific Patient Office Policy

North Pacific New Patient Intake Form

North Pacific HIPAA

Skin Surgery Center Health History Form

Skin Surgery Center Registration Form

Skin Surgery Center Financial Policy Form

Skin Surgery Center Contact Consent Form

Skin Surgery Center Notice of Privacy Practices (HIPAA) Form

Skin Surgery Center Patient Rights and Responsibilities - Please Read

Skin Surgery Center Cancellation and Late Policy - Please Read

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This is not a secure exchange and not to be used for appointment requests. Please contact the office directly. Please refrain from sharing personal health information. If you need assistance with a medical issue or have a medication question, please call us. Inquires will be responded to on the next business day.

About Us

Areas We Serve

Bellevue, WA - North Pacific Dermatology

Renton, WA - North Pacific Dermatology

Eastside Dermatology

Lake Washington Dermatology

Seattle - Skin Surgery Center

Bellevue - Skin Surgery Center

Caring, Comprehensive Dermatology Services

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