To refer a patient to any of our dermatologic surgeons, please:

• Fax this form , the patient's chart notes and pathology report to 503-346-8103 (fax)
  
• If you would like to check on available dates or schedule the appointment for your patient, call 503-494-6483 (voice)
  
• Send the pathology slide with a copy of the pathology report to:
  

  OHSU Department of Dermatology
  Dermatopathology – CH5D
  3303 SW Bond Ave
  Portland, OR  97239
  

We are flexible and will work with either the referring physician or the patient to schedule appointments.

Please note:
All melanoma pathology reports and slides must be received and reviewed prior to date of surgery.