Tri-City Dermatology | Dr. Jeremy Peck | Richland Dermatologist logo for print

112 Columbia Point Dr., Suite 105
Richland, WA 99352

Phone: (509) 873-7140
Fax: (509) 818-1303

Tri-City Dermatology is committed to staying safe during the COVID-19 pandemic.   Learn More

Patient Forms

Patient Forms Packet

Please print and complete these forms before your appointment and fax them to our office or bring them with you to your appointment.

Individual Forms

If you need an individual form found it the packet above, please choose that form from the list below.

Medical Records Release

Please use the form below to authorize release of your medical records to Tri-City Dermatology from another medical practice.

Notice of Privacy Practices

For Referring Providers