To All Our New and Existing Patients
Before your appointment, please complete or update your Medical, and Dermatologic History, and other requested information via the EHR Portal. Be sure to complete the Patient Forms listed below if you have not already done so this calendar year. This will expedite your visit and save you time when you’re in our office.
To access our electronic record system click here and use the username [your email] and password that were sent to when you registered with us.
If you didn’t receive or no longer have the password, you can reset using the above link. If you have neither your user name nor password, call our office, and make sure we have your correct email so we can resend it to you.
Please review the instructions for navigating through the portal. This will take you through each section step by step.
Complete all the information requested in each purple tab on the left side of the page: your medical, skin, medication, allergy history, pharmacy, etc. Be sure to complete, and check the option NONE for each section that is not applicable to you. Remember to Click “Save and Continue” after you complete every section.
The Chrome browser works best if using a computer with this electronic record system. If you have not already done so, you may download Chrome here or you can use your iPad.
Given the realities of COVID -19, please download and complete these forms before your appointment so that we can minimize your waiting time, and room you directly. This applies to both New Patients, and Existing Patients, not yet seen this calendar year, fax to (415) 383-1275 to Mill Valley, or bring them with you to our office. Please DO NOT EMAIL any forms to us as they will contain your confidential personal information and not be encrypted.
- Patient Information
- COVID-19 Informed Consent Agreement
- Telemedicine Informed-Consent COVID-19
- Medical & Dermatologic History
- Medicare Patient Registration
- Notice of Receipt of Privacy Practices
- Insurance and Financial Policy
- Government Mandated Questionnaire
Please bring with you the bottles of all your prescriptions so we can review their instructions.
Please plan to arrive 15 minutes before your appointment time, with your valid current insurance card, driver’s license or ID, and be prepared to pay any co-pay or deductible dictated by your insurance plan.
PLEASE REVIEW COVID -19 SYMPTOMS
Have you had any of one of these SYMPTOMS in the past 24 hours or during the past 14 days?
- 1. Fever of 37.8°C/100°F or higher, chills/shakes
- 2. Sore throat
- 3. Shortness of breath or difficulty breathing
- 4. Unexplained muscle aches
- 5. Cough
- 6. Loss of senses of smell or taste
- 7. Nasal, congestion, runny nose, or sneezing (different from pre-existing allergies)
- 8. Diarrhea (3 or more loose stools in 24 hours, different from pre-existing conditions)
- 9. Eye redness +/- discharge (Pink eye, not allergy)
- 10. Have you or someone at home tested COVID-19 positive?
In the past 14 days:
- 11. Have you been exposed to anyone who has any of the above symptoms? Or to someone who tested positive to COVID-19?
- 12. Have you traveled outside the U.S. or on an airplane?
- 13. Had anyone at home who has had any symptoms of or tested positive for COVID-19?
- 14. Been confirmed/diagnosed yourself as having COVID-19?
- 15. Have you worked at a health care facility and participated in the direct care of patients diagnosed with COVID-19?
IF YOU ANSWER AFFIRMATIVE TO ANY OF THE ABOVE – WE WILL BE UNABLE TO SEE YOU
Please call your Primary Care Provider or your County Health Department for COVID -19 testing and guidance.
You may contact us after testing negative to COVID- 19, and being symptom-free for a 14 day period beginning when you have not had a fever for 3 Consecutive Days, and are not taking Tylenol, aspirin, or ibuprofen [all of which would suppress a fever]. If after that time, you still have persistent respiratory symptoms [like a cough], you will need additional clearance before being seen.
— Jeffrey H. Binstock, M.D. and Associates
Office: 415 383-5475
Fax: 415 383-1275