PACIFIC DERMATOLOGY

Phone: (360) 834-2000 ~ Fax: (360) 834-2009
15613 SE Mill Plain Blvd. Vancouver, WA 98684

Schedule Appointment

Forms

Do Not send completed forms via email!  Only use email, IF you are “replying” to an encrypted email sent by our office.

After downloading and filling out the forms, there are only three appropriately secure ways to send them to us.  Please help us protect your privacy and only use one of these three options.

1.    Mail them to our office:  Pacific Dermatology, 15613 SE Mill Plain Blvd., Vancouver, WA 98684

2.    Fax to our office: (360) 834-2009

3.    Attach and reply to an encrypted email that we send to you from our office. 
Do Not send completed forms via email!  Only use this email option, IF you are “replying” to an encrypted email sent by our office.

Download Intake Form

Download Telehealth Consent Form

Download Notice of Privacy Practices.  For reference only — Do not return this form.