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 need our records sent to another office, please download and fill out the form below.
Click to download: Medical Release Form
Prior to your appointment please download and fill out the Insurance, Privacy Communication and HIPPA Forms below. Please call prior to your appointment 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!
Click to download: Patient Intake Form
Click to download: Patient Office Policy
Click to download: Signature Sheet
Click to download: Cancellation Policy
Click to download: Privacy Policy
If you were a patient of Dr. Chiu’s at Pacific Dermatology & Cosmetic Center, fax the form to:
425.974.1233
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
