Patient Questionnaire (adult)
Download our patient questionnaire for new patients
Download our pediatric questionnaire for new pediatric patients
Do you need a copy of your dermatologic health care records?Please print and fill out the appropriate form below. Once signed and completed, fax or mail to:
OHSU Department of Dermatology
3303 SW Bond Ave, CH16D
Portland, OR 97239
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Please note that if you are looking for records before the year 2006, processing may take an extra 48 hours from the time we receive the request. Standard processing time is 48 hours from time we receive the request. Patients with larger files may take extra processing time. Any questions regarding your request please contact us at 503-418-3376.
You can also access portions of your record via MyChart. If you do not have access to this online portal to your health record, contact us at 503-418-3376 or see one of our staff members for assistance.
Authorization to Use and Disclose Protected Health Information
Download a Request for Records form: