425.732.2677
Diane Chiu, M.D., Board-certified Dermatologist
1200 112th Ave NE, Suite C-187 | Bellevue, WA 98004 Diane Chiu

Patient Forms

It is very helpful for Dr. Chiu to have information about your prior skin health history. Please download and fill out the Medical Record Release Form and send/fax it to your previous physician.

Click to download: Medical Release Form

If you were a patient of Dr. Chiu’s at Pacific Dermatology & Cosmetic Center, fax the form to: (206) 859-5776.
Please call them at (206) 859-5777 to make sure the form was received.

If you were a patient of Dr. Chiu’s at Virginia Mason, please visit their website for instructions on obtaining your records: Virgin Mason: Medical Records

Please call prior to your appointment with us to verify that we have received your records. This will enable Dr. Chiu to provide you with the best possible care at the time of your visit. Thank you!

  • Phone:

    425.732.2677

    Fax:

    425.457.7499

    Address

    1200 112th Ave NE
    Suite C-187
    Bellevue, WA 98004