Welcome to San Luis Dermatology & Laser Clinic

The San Luis Dermatology and Laser Clinic has been serving the San Luis Obispo area in the person of Dr. Jeffrey Herten since October, 1977. From a one doctor, one nurse, one front office person practice in an 800 square foot office, the clinic has grown into a four physician, and twenty support staff practice in a state-of-the-art 3900 square foot facility, and newly added second location.

 

 

New Patients

 

  Michael Heffernan, M.D., Joseph W. Diehl, M.D., and Cheryl Ketelsen, PA-C are all currently accepting New Patients. Please call the office directly to schedule your New Patient appointment (805) 541-2650 or (805) 541-4180. 

       

You can download and print our New Patient Forms by clicking on the blue links below.

Please make sure to bring your Insurance cards, Photo ID, and legible list of Medications to include dosage to all appointments.

 

Thank you. 


 New Patient Forms: Please print and fill out the three forms below and bring to your New Patient appointment.           

1.  New Patient Information 9-1-17.pdf

2.  Health History Intake Form 9-1-17.pdf

3.  HIPAA Release 9-1-17.pdf

           

All patients please review Office Payment and Cancellation Policy below.

Thank you.

     Authorization of Pymt Policy 9-1-17.pdf

     Cancellation No Show Policy 9-1-17.pdf

 

 Miscellanous Forms:

    Authorization for a MINOR 9-1-17.pdf

    Credit Card Authorization 9-1-17.pdf

   

    Authorization to Release Records to Outside Physician - Santa Rosa Office.pdf

    Auth to Release Medical Records to Patient - Santa Rosa Office.pdf

    

    Authorization to Release Records to Outside Physician - Bishop Office.pdf

    Auth to Release Records to Patient - Bishop Office.pdf