Patient Resources

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms, ahead of time, you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Pacific Dermatology and Cosmetic Center | Patient Info | Payment Info | Seattle | Renton WANote: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.

* Please download the file to your computer and use the Adobe® Reader® to fill out and save or print the patient forms.


Payment Options

carecreditWe accept cash, checks, major credit cards including Visa, MasterCard, and American Express. We also have a payment plan available through CareCredit for all procedures over $300.00. To apply for CareCredit online, click the following link: CareCredit Application

credit cards


Appointment Procedures

Please call Monday - Friday 8:00AM - 5:00PM to schedule an appointment.


Cancellation Policy

We understand if you cannot make your appointment and need to reschedule. However, please call 24 hours prior to you appointment for ANY cancellations. We reserve the right to charge $50.00 for any no-show appointments (or cancellations without 24 hour notice).


Insurance Plans

All major insurance plans including Medicare, Regence, Premera, United Health Care, Aetna and Cigna, Tricare.

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Thank you for choosing Pacific Dermatology & Cosmetic Center, we look forward to providing you with the very best skin care.

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