Patient Forms

New Patients:

Completing these forms PRIOR to your visit will shorten your registration time.

• Allergy Patient Paperwork
• ENT Patient Paperwork
• Medications to Avoid Prior to Skin Testing

Immunotherapy Patients:

• Authorization to Prepare Allergen Extract
• Allergy & Asthma immunotherapy Re-Evaluation
• Immunotherapy Treatment Acknowledgement Letter
• Allergy Extract Release Form
• Allergen Immunotherapy Frequently Asked Questions
• Immunotherapy First Injection Visit
• Safety is Our #1 Concern

Audiology Patients:

If you or your family feel you are having difficulty communicating due to hearing loss, take our Hearing Loss Questionnaire.

• Hearing Loss Questionnaire

Telehealth:

• Patient’s Guide to Virtual Visit
• Informed Consent and Pre-Authorization Auto Credit Payment Form for Telemedicine Service
• Advance Beneficiary Notice of Noncoverage (ABN) (English)
• Advance Beneficiary Notice of Noncoverage (ABN) (Spanish)

Authorization for Release of Health Information

Notice of Privacy Practices and Disclosure of Protected Health Information