Allergy
& Asthma Consultants, Ltd.
Online Forms
Library
New Patient Enrollment Packet
These
forms are for your initial appointment. Please read
and complete ALL forms in this file, prior to your initial
appointment. The more information the
doctors have about your symptoms, the sooner we should
be able to help you.
Privacy Notice
This form is for all of our patients. Please read our
HIPAA Privacy Policy.
Medical Records Release Form "TO" Allergy
& Asthma Consultants, Ltd.
If you have medical records from another physician's office
that you feel may be relevant to your allergy appointment,
complete this form. You can either bring it to your
initial appointment or with time permitting, give it to your
referring physician so your records will be available for
review during your appointment.
Medical Records Release Form "FROM"
Allergy & Asthma Consultants, Ltd.
If you need medical records sent to
another physician's office, (example: due to relocation
out of state) then you can complete this form. You can
either bring it to one of our offices or fax it to us.
(See our locations page for
addresses and fax numbers.)
Vial Authorization Form
This form is
for those patients that have already been seen at
Allergy & Asthma Consultants and have been advised that
they may benefit from allergy injections. We will need
this completed authorization form prior to making your
allergy serum(s).
These forms are in PDF format which requires
you to have Adobe Reader to view and print them.
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