What to Bring to Your Appointment 

To prepare for your appointment, be sure you have the following items:

  • Driver’s license or photo ID
  • Current health insurance card
  • Insurance co-pay or self-pay options 
  • List of current medications or supplements 
  • Completed forms as requested

New Patient Forms

Prior to your appointment, you may be instructed to download and print these forms. Please complete the forms and bring them with you to your first appointment. 

Information for Minor Patients 

All patients under the age of 18 must be accompanied by a parent or guardian for their first appointment. 

Notice to Patients 

Silver Falls Dermatology & Allergy complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Silver Falls Dermatology & Allergy does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Silver Falls Dermatology complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Silver Falls Dermatology & Allergy provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreter
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages

Spanish

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-503-362-8385 (TTY: 1-866-574-1399).

Vietnamese

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số 1-503-362-8385 (TTY: 1-866-574-1399).

Chinese

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-503-362-8385 (TTY: 1-866-574-1399)。

Russian

ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.  Звоните 1-503-362-8385  (телетайп: 1-866-574-1399).

Korean

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-503-362-8385 (TTY: 1-866-574-1399) 번으로 전화해 주십시오.

Ukrainian

УВАГА!  Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки.  Телефонуйте за номером  1-503-362-8385 (TTY: 1-866-574-1399).

Japanese

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-503-362-8385 (TTY: 1-866-574-1399). まで、お電話にてご連絡ください。

Arabic

ملحوظة:  إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم (رقم هاتف الصم والبكم: 866-574-1399, 503-362-8385

Romanian

ATENȚIE:  Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit.  Sunați la 1-503-362-8385 (TTY: 866-574-1399).

Cambodian

ប្រយ័ត្ន៖  បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។  ចូរ ទូរស័ព្ទ 1-503-362-8385 (TTY: 866-574-1399)។

German

ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer: 1-503-362-8385 (TTY: 866-574-1399).

French

ATTENTION :  Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.  Appelez le 1-503-362-8385 (ATS: 866-574-1399).

Thai

เรียน:  ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี  โทร 1-503-362-8385 (TTY: 866-574-1399).

Notice of Privacy Practices

Your health information includes information about your health history, health status, symptoms, examinations, test results, diagnoses, treatments, procedures, prescriptions, related billing activity and similar types of health-related information.

We are required by law to notify you about the ways in which we may use and disclose health information about you, and to describe your rights and our obligations regarding the use and disclosure of that information. Read the full notice here.

Confidential Hotline

Employees, providers, patients and teammates can report compliance concerns safely and anonymously.

  • Workplace issues
  • HIPAA and security
  • Coding compliance
  • Stark laws or anti-kickback violations
  • Any other sensitive subjects

Safe Hotline is an independent third-party service that can be used to report concerns for any of our locations. All reports received will be submitted exactly as they are received, and your identity will not be disclosed without your permission.

The hotline is easily accessed by phone, text or online. Our company code is required with every report, so that concerns can be properly directed.

Call or Text
1-855-662-SAFE
(1-855-662-7233)

Online
SAFEHOTLINE.COM

Company Code (required)
0777756263

Once a report is made, the person is given a onetime key code that can be used to check the status of the report.

The compliance hotline is not an emergency number and should not be used in place of 9-1-1.

Telephone Relay Service

Oregon Telecommunications Relay Service is a free public service for communication between standard (voice) users and persons who are deaf, hard-of-hearing, deaf-blind, and speech-disabled using text telephones (TTYs) or PCs via the Internet.

  • Voice
  • TTY
  • ASCII
  • TeleBraille
  • Spanish
  • Voice Carry-Over
  • Speech-to-Speech
  • Hearing Carry-Over
  • 900 Toll Service
  • International Calling
  • TTY Public Payphones
  • Directory Assistance
  • Answering Machine
  • Emergency Call

If you have difficulty using the telephone, please use this HIPAA-Compliant service to communicate with our office or make appointments.

Oregon le ofrece el servicio de relevo a nuestros clientes en español. Los consumidores de TTY pueden escribir por máquina en español y las conversaciones serán retransmitidas en español y ingles.

http://www.oregonrelay.com/