New Patients and Forms
Your first visit to Phoebe Rich Dermatology establishes a crucial foundation for our relationship with you. During the initial visit, we obtain your medical history and any other information that may be pertinent to maximizing the benefits of your visit.
Below you will find directions, office hours, and links to new patient paperwork. To save you time before your first visit, you can print out our paperwork and bring the completed forms with you to your appointment. If you'd prefer to fill out the paper in our office, we ask that you arrive at least 15 minutes prior to your appointment.
Our practice is working together to realize a shared vision of uncompromising excellence in dermatology.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve
- Earning the trust and respect of patients, professionals and community
- Exceeding your expectations
- Ensuring a creative, challenging, and compassionate professional environment
- Striving for continuous improvement at all levels
Patient Forms & Preparing for Your Visit
All new patients are required to fill out the Patient Registration, Health History, Notice of Privay Practices Acknowledgment, and Genetic Testing Participation forms. Depending on what issues you are being seen for, you may also be required to fill out the forms that relate to the specific reason for your visit.
If you are a returning patient, but have not had an appointment within 3 or more years, we ask that you please fill out a new Health History form and bring it with you to your visit. In addition to completed paperwork, feel free to bring anything else you think might help your provider better understand your concerns. This includes, but is not limited to, additional health histories, chart notes, and a list of any medications or topical treatments that you may be using at the time.
Click the links below to download our required forms:
- Patient Registration
- Health History
- Notice of Privacy Practices
- Notice of Privacy Practices (Spanish)
- Notice of Privacy Practices Acknowledgment
- Genetic Testing Participation
Please also complete one of the following forms ONLY if it pertains to the reason for your visit:
- Acne History
- Hair Loss History
- Dermatitis (Eczema, Rash) History
- Nail History
- Psoriasis History
- Hyperhidrosis Evaluation
- Financial Policy
- Records Request (sending records to our office)
- Records Release (sending records from our office)
In order to view or print these forms you will need to have Adobe Acrobat Reader installed. Click the link below to download and install:
Download Adobe Acrobat Reader
Map and Directions
We are located near the corner of 25th and NW Lovejoy St., close to the NW 23rd Shopping District. Our office is in the upper level of a small brick building right off of Lovejoy St., in Suite 200. We have a parking lot next to our building.