Patient Forms And Information
Patient forms need to be printed, filled out and brought to the office. Please do not submit your forms through the website.
To save time on the day of your appointment, please fill out these forms and bring them with you:
- CDLS Patient Registration Form
- CDLS Patient History
- CDLS Financial Policy
- CDLS Authorization to Release Healthcare Information
- Consent to Treat a Minor
- Notice of Privacy Practices
- New Patient Paperwork Packet (Spanish)
Please do not fill out any patient paperwork from the portal, this does not get to the office please see patient forms on this website to print, complete and bring to the office with you.
If you do not have a copy of Acrobat Reader you can get one for free by clicking on the Acrobat® Reader icon. This will take you to Adobe’s website and enable you to download the Acrobat program to your computer.
Accepted Forms Of Payment
We only accept cash or card for Product purchases and Cosmetic appointments.
- Credit Card: American Express, Discover, MasterCard, VISA
CareCredit® Healthcare Credit Card
We accept CareCredit®, the healthcare credit card designed specifically to help finance your health and beauty needs. CareCredit® can help you move forward with getting the procedures you’ve always dreamed of with special financing on purchases of $200 or more. CareCredit® is the credit card exclusively designed for healthcare services like cosmetic dermatology. Provided you have credit available, you can also use your card over and over for follow-up appointments or for different procedures.
Subject to credit approval. Minimum monthly payments required. Visit www.carecredit.com for details.
Accepted Insurance Plans
- Coventry Health Plans
- First Health – Group Health Only
- First Choice Health Network
- Great-West Healthcare
- Humana Gold Plus
- Kaiser Permanente – Added Choice
- Managed Health Care NW (MHN)
- Pacific Source – Choice – PPO – Preferred
- Providence Health Plan – Medicare – EPO – PPO
- Providence Preferred
- RailRoad Medicare
- Regence BCBS
- Tuality Health Alliance (pending)
- United Healthcare
Keystone Medical Management