Dermatology & Skin Care Center of West Linn

New Patient Forms (PDF)

New Patient Forms (PDF)

No Surprises Act: This federal law gives uninsured patients and those who elect to be self-pay the right to receive a Good Faith Estimate for the total expected cost of non-emergency services. We will provide a Good Faith Estimate in writing if you are uninsured, out-of-network, or choose to be self-pay, prior to your appointment.

We will provide a Good Faith Estimate in writing if you are uninsured, out-of-network, or choose to be self-pay, prior to your appointment.

As a patient, you have the right to initiate the patient-provider dispute resolution process if the balance owed is substantially more than the expected charges listed on the Good Faith Estimate. To find more information and start this process, go to https://www.cms.gov/nosurprises or call 1-877-696-6775.

For information on dispute resolution under No Surprises Act, visit https://www.cms.gov/nosurprises or call 1-877-696-6775.