Patient Information, Forms, and Insurance
Welcome to Yamhill Valley Dermatology and Laser Center, a dermatology and dermatologic surgery practice begun in 1979 by Dr. Richard Ecker, a board certified dermatologist. Our goal is to provide the highest quality of personalized service for the diagnosis, treatment and cosmetic improvement of your skin. We welcome your questions, comments, and the opportunity to serve you.
Please complete the forms needed before your appointment by (1) printing the forms, (2) filling them out, and (3) bringing them with you to the office, or by coming into the office 30 minutes before your scheduled appointment. *You may be required to first save the form before printing* By completing these forms now, you can gather the necessary information needed before your appointment and see you in a timely manner.
You must bring your insurance card(s) and photo identification to your appointment. All copays and co-insurance are due at the time of service.
Medical History (Espanol)
Medication Sheet (Espanol)
Financial Policy (Espanol)
Appointments (Ext. 101)When you call for an appointment, the receptionist will ask the nature of your visit. If you have several problems to discuss, please let us know so we can reserve enough time. We ask that you arrive 15 minutes before your scheduled appointment time to complete any necessary paperwork. Your appointment time is reserved for you. If you cannot keep your appointment, please let us know at least 24 hours prior to your appointment. This way we'll be able to offer your time to another patient.
Referred Patients If your insurance plan requires authorization from your Primary Care Physician (PCP) for specialty care, it is your responsibility to obtain this authorization prior to your scheduled visit in our office. If you’re unsure whether a written referral is needed, please review the terms of your health insurance coverage, contact your PCP, or call your insurance company.
Insurance and Billing (Ext. 104)Health care insurance is intended to cover some, but not all of your medical expenses. Most plans include a co-pay, deductible, and/or other expenses which must be paid by the patient.
We have signed contracts with many insurance companies in Oregon. However, it may be necessary that you contact your insurance company to verify whether Yamhill Valley Dermatology and Laser Center is contracted with them.
You will need to bring your current insurance card and a photo ID for each visit. This is to assure we protect your personal identity as well as bill the correct insurance company.
Our goal is to help you receive the maximum benefits to which you are entitled. All patients, regardless of their insurance plan, will be asked for payment of their deductible, coinsurance and any co-payments at the time of service.