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 them out and bring the completed forms with you to your visit, or we have forms at our office location you can fill out upon arrival. We ask new patients that are going to be filling out paperwork at our office to arrive at least 15 minutes prior to their appointment to fill out the appropriate paperwork.
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.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
Patient Forms & Preparing for Your Visit
All new patients are required to fill out a patient registration, medical history, Notice of Privay Practices Acknowledgment, and genetic testing forms. Depending on what issue you are being seen for, please fill out the correct questionnaire(s) that relate to your visit. If you are a returning patient, but have not had a visit within 3 years or longer, we do kindly ask that you fill out a new medical history questionnaire and bring it with you to your visit. After completed paperwork is done, feel free to bring anything else you think might help your provider better understand your concern. This includes, but is not limited to, additional health histories, chart notes, a list, or physical form of any medications or topical treatments that you may be using at the time.
- Patient Registration
- Medical History
- HIPAA Notice of Privacy Practices
- HIPAA Notice of Privacy Practices- Spanish
- NOPP Acknowledgment
- NOPP- Spanish
- Genetic Testing
Please complete one of the following if it pertains to your visit:
- Acne Questionnaire
- Hair Loss Questionnaire
- Dermatitis History
- Nail Questionnaire
- Psoriasis Intake
- Hyperhidrosis Patient Information
- Financial Policy
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
Map and Directions
We are located near NW 23rd Shopping District in Suite 200, upper level of the brick building.