If you are a new patient to our Allergy clinic or an established patient but have NOT been seen in our Allergy clinic in past 3 years, please download the Allergy new-patient forms by clicking here.

Please fill the New Patient Info form prior to checking in for your scheduled appointment.

Please call the Allergy office at (360) 413-8265 if you have any questions.

Click here to download the ALLERGY new patient forms

If you are a new patient in our Mohs Surgery clinic or an established patient but have NOT been seen in our  Dermatology clinic in past 3 years, please download our Mohs Surgery new-patient forms by clicking here.

To save you time and speed up the check-in process, please fill out all forms prior to coming in for your scheduled appointment.

Please call our Mohs Surgery appointment desk  at (360) 292-7700  if you have any questions.

Click here to download the  Mohs Surgery  new patient forms

The following outlines our mutual business responsibilities and allows us to provide quality, timely and complete health care.

 Patient Responsibility

• Bring your current insurance card(s) and picture ID at each visit.
• Notify us of a change of address, telephone numbers, employer or insurance.
• Pay your co-payment, charges for non-covered services or any outstanding balances at the time of your visit.  Your co-payment will be collected at the time of services – no exceptions. If there is no copay made at time of visit, a $10.00 surcharge will be added. We accept cash, checks, Visa, and Master Card.
• Obtain any necessary referrals / authorizations prior to the visit, if your plan requires this to see a specialist.
• Contact the Business Office prior to the visit if you have no insurance to make payment arrangements if you cannot pay in full. Otherwise, patients with no insurance are expected to pay in full at the time of service. 
• Call at least 48 hours in advance if you cannot make your appointment to avoid a “missed appointment” fee of $50.
• Angry or foul language directed at our staff is not tolerated and will be grounds for immediate dismissal from our practice.

Dermatology & Allergy Specialists Responsibility

• Commercial Insurance Patients: If we participate with your plan, we will bill your insurance for you. If we do not participate with your insurance, we will file your claims as a courtesy. Please understand that since we do not have a contract with your plan, we are not obligated to adjust our charges based on your plan’s coverage or benefits.  If we do not receive payment from your primary carrier within 60 days of filing, you may be billed for the entire amount. Payment is due 10 days after receipt of the statement.

• Medicare Insurance patients: We are participating providers with Medicare and will bill Medicare for all your covered charges. If you have supplemental insurance, we will also bill that for you. If payment is not received from your supplemental insurance within 60 days of being submitted, we may bill you for the balance due. If you do not have a supplemental insurance, your portion (20% of amount allowed by Medicare) may be collected at the time of service, along with charges for non-covered or cosmetic services (you will be asked to sign an Advance Beneficiary Notice form in the event that a service is provided which we expect Medicare will not pay for).

• Finance Charges:  We reserve the rights to assess a 1% monthly interest charge on unpaid balances over 60 days old
• If we have not received payment in full after 90 days from the date of service, we reserve the right to refer your account to an outside collection agency where you will be responsible to pay the costs of collection including court costs and reasonable attorney fees to be determined by a court of law. Any legal action shall be brought and maintained exclusively in a state court of Thurston County, State of Washington and the parties hereby submit themselves to the personal jurisdiction and venue of those courts for the purpose of any such action and hereby waive any defense related to personal jurisdiction, process or venue brought in those courts. If your account is turned over to collections or you have an unpaid balance, 90 days or older, you may no longer be able to be seen at Dermatology and Allergy Specialists of Olympia, PLLC.  A fee of $25 will be charged to any account with a check returned unpaid by the bank.

Click here for our Privacy Practices