Patient Forms

Patient Forms

Patient Questionnaire (adult)

Download our patient questionnairePDF Icon for new patients

Pediatric Questionnaire

Download our pediatric questionnairePDF Icon 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


- or -


Fax: 503-494-6968

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:

Patient Authorization and Consent for E-mail Communications with OHSU Healthcare Providers

Download the E-mail Communications consent form PDF Icon