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AN IMPORTANT NOTICE ABOUT YOUR CARE DURING THE COVID-19 PANDEMIC

Your care and safety are our top priorities. As we continue to provide the highest-quality patient care possible, we have implemented new safety protocols. These include but are not limited to, contactless patient registration procedures which require completing your patient paperwork prior to your appointment and having a credit card on file.

We understand that as individuals and as a community we have had to process many changes during the pandemic. Considering this, we have created a resource to help make your dermatology appointment as smooth as possible. Please take a moment to read our Special Message to Patients Regarding coronavirus, COVID-19. Here you can find a great deal of information about our new safety measures and procedures as they relate to the pandemic.

Covid-19 Patient Notice

New Patients

CONTACTLESS PATIENT REGISTRATION

We ask that all new patients use this Patient Portal to submit patient registration forms prior to their appointment to facilitate contactless patient registration and payment.

New Patient Registration

Please print and complete the forms below if you are unable to access our secure patient portal. You will need the below Patient Forms that include a Patient Information form, Medical History form, Credit and Cancellation Policy, and HIPAA Privacy Policy, which all need to be completed before your first visit. You can print, sign, and fax the Patient Forms to 541.382.2605 or email them to info@bendderm.com.

Patient Forms

Click on each arrow to download.

Patient Forms (English)

Patient Registration Form

Release of Information Consent

Release of information consent

Notice of Privacy Practices

Conditions of Treatment

HIPAA Policy Acknowledgement

HIPAA Policy acknowledgement

ACH Credit Card Payment Authorization

Medicare Patients Only. MSP - Short Form

Formularios del Paciente (en Español)

Formularios de Registro de Pacientes

Aviso de prácticas de privacidad

Reconocimiento de Recibo HIPAA de Notificacion de Practicas de Privacidad

Autorización de Pago por Tarjeta de Crédito

Cuestionario del Pagador Secundario de Medicare

Existing Patients

Use the Patient Portal to:

Billing – Make a Payment
Request an Appointment
Access Patient Registration Forms for Contactless Patient Check-in

Use the Medical Information Portal to:

Access your Lab Results, Visit Notes and Medical Records
Request Medication Refills
Update your Health History

Patient Portal

Medical Info Portal

Creating Your Patient Portal Account

Reset Your Patient Portal Password

Completing Your Patient Forms

Insurance

If your insurance covers dermatological treatments, you will receive the benefit of reduced out-of-pocket costs. Because insurance policies vary, we review each case individually to determine the best course of action for you. Additionally, some plans require a referral from your primary care physician so it’s a good idea to check with your insurance company for specific requirements.

insurance plans Accepted

Please check with your individual insurance carrier for coverage.

Bend Dermatology will bill most carriers on behalf of our patients. However, our office can never guarantee your personal coverage or benefits. Only your insurance company’s customer service department can guarantee that our providers are in their network.

In-House Prescription Program

Our in-house prescription program provides a convenient option for our patients to receive many common prescriptions at the time of their appointment. Medication is customized to each patient’s unique needs. Prescriptions are purchased directly from our office to save our patients an extra trip to a separate pharmacy.

Bend Dermatology is accredited with the Physician Dispensing Association, a process where we demonstrated compliance with national standards. This reflects our dedication and commitment to meeting and exceeding standards which facilitate a higher level of performance for patient care.

for patients