Patient Forms

NEW PATIENTS:

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

**Please fill out form 1 OR 2 (depending on your type of visit) as well as forms 3-7 below, and bring those to your first visit…

• 1- New Patient Questionnaire – Allergy
• 2- New Patient Questionnaire – ENT
• 3- New Patient Consent Forms
• 4- New Patient registration
• 5- Privacy Notice
• 6- Health Care Team
• 7- Assignment of Benefits & Release Information
• 8- Contact Consent 
• 9- Medications to Avoid Prior to Skin Testing

RETURNING PATIENTS:

Print and complete the Established Patient Form no more than 24 hrs before your visit to shorten wait time.

• 1- Established Patient Questionnaire- ALLERGY
• 2- Established Patient Questionnaire- ENT
• 3- Established Patient Demographics
• 4- Medical Records Release 
• 5- Medications to Avoid Prior to Skin Testing

IMMUNOTHERAPY PATIENTS:

• 1- Authorization to Prepare Allergen Extract
• 2- Allergy & Asthma immunotherapy Re-Evaluation
• 3- Immunotherapy Treatment Acknowledgement Letter
• 4- Allergy Extract Release Form

AUDIOLOGY PATIENTS:

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

• 1- Hearing Loss Questionnaire