Patient Forms

NEW PATIENTS:

Completing paperwork PRIOR to your visit will shorten your registration time. Please fill out the appropriate form below for your type of visit (Allergy or ENT, not both).

• Allergy Patient Paperwork
• ENT Patient Paperwork
• 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
• 5- Allergen Immunotherapy Frequently Asked Questions
• 6- Immunotherapy First Injection Visit
• 7- 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.

• 1- 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