Troy H. Dillard, MD
 Terry Noyes, PA-C
 Jessica Gow-Lee, FNP-BS
6485 SW Borland Road, Suite B, Tualatin, OR 97062  Voice:800.363.6499  Fax:866.600.0813

New Patients: First Visit

** NOTE: We are NOT accepting NEW MEDICARE, MEDICAID, OR OREGON HEALTH PLAN **

Contact us to schedule an appointment:

 

Call:  (800) 363-6499 
or 
Use the following form (preferred):

Fill out this form to contact our scheduling department

First Name: *
Last Name: *
Address:
 Date of Birth: *  
Home Phone:
Cell Phone:
Email: *
Insurance: *
 Referring Provider *  
Reason for Visit: *


ONLY AFTER YOU HAVE YOUR APPOINTMENT SCHEDULED:


Provide us with your medical history:    

     Complete On-Line
or Print the Forms (fill out and bring with you)



Print, fill-out and bring Consents and Demographics:
     
Consents and Demographics 


Review our Privacy Practices (optional to print a copy):

     Notice of Privacy Practices  (optional to print)

Forms Require FREE Adobe Reader, Download Here




Read the Sections Below to Prepare for Your Visit


Welcome to Northwest Endocrinology, LLC. We strive to provide you with caring and comprehensive medical evaluations and the most advanced treatment options available to resolve your health issues.

What to Expect on Your Visit

Please arrive at least 10 - 15 minutes before your scheduled visit time to fill out any relevant paperwork.  Please see review the Late Policy below.

Patient consultation: please allow at least one hour for your initial appointment.

While our goal is to see patients at their scheduled appointment time, our doctors must occasionally attend to emergency situations.  If an emergency arises, we will do our best to notify you prior to your appointment; however, that is not always possible. Your patience and understanding are greatly appreciated.
  • Please bring a photo ID and insurance card to every appointment.
  • Bring a list of ALL your medications
It is best that you have ALL your pertinent records sent to our office at least 2 weeks in advance of your visit for review. For instance, if you have already been treated with medications, bring a copy of the list of medications. If you have undergone specific tests, have those results forwarded as well. This can save you time and money by not having to repeat these tests or wait for follow up appointments just to review them again. We want to make your appointment as efficient as possible.

Cancellation Policy

As a specialist practice, this office is considered a limited resource for our community. Many patients must wait unnecessarily for an appointment due to no-show appointments.  "24 hour notice of cancellation of appointment" is required, which means that cancellation must be made by 10:00am prior to the day of the scheduled appointment.  There will be a charge of $200.00 (not covered by insurance) for each no-show new patient visit, ultrasound, biopsy or consultation. After 2 no-shows for a new patient appointment, a patient will not be offered the privilege of rescheduling the appointment.  For established patients, there will be a charge of $75.00 (not covered by insurance) for each failure to provide 24 hour notice of cancellation of appointment.  A patient who accumulates a total of 3 missed appointments may be asked to leave our practice.  Although we bill insurance companies as a courtesy, the patient is responsible for their account. Please review the Services and Financial Agreement and Consent prior to booking your appointment.

Late Arrival Policy
We are committed to prompt service, and will work very hard, barring emergencies, to stay on time. If you arrive for your scheduled appointment either 10 minutes late or later or half of the duration of your scheduled visit (30 minutes late for a 1 hour appointment, for example), it is at the discretion of the physician to see you or ask you to reschedule.  This is a matter of respect for the physician and other patients in our practice.  If it is determined that the physician will see you, other scheduled patients will not be delayed in order to accommodate you.  You may have to wait until an appropriate opening is available. However, this might mean that patients who arrived on time will be seen ahead of you.  Always arrive 10 to 15 minutes early for an appointment to complete any paperwork associated with your visit.

Insurance Information

As a patient of this practice, you must understand your rights and obligations. Professional services are only billed to third party payors in accordance with standard office practices and third party policies. 

The insurance company will only pay for treatment AFTER services are provided. Your insurance company may deny payment based on non-covered benefits, pre-existing conditions, lack of benefits, or other reasons that you should discuss with your insurance company directly for full disclosure. In addition, part of your charges may be applied to your deductible, and you are liable for these charges according to the agreement with your insurance company.

BE AWARE: We can in no way guarantee you that your insurer will cover the cost of your treatment. It is always your responsibility to understand your current insurance benefits and to discuss this with your insurer prior to receiving treatment. You will ultimately be responsible for the balance of any unpaid charges.  Again, please review the Services and Financial Agreement and Consent prior to booking your appointment.