NEW PATIENT INFORMATION

Welcome to our office! We are delighted to meet you and look forward to your visit.
Prior to your appointment, we ask that you print and complete these forms.

1. New Patient Registration Form
2. Patient History Form
3. Notice of Privacy Practices Acknowledgement Form
        Notice of Privacy Practices
4. Office Policies and Procedures
5. Credit Card on File Authorization Form

INFORMATION TO BRING TO FIRST APPOINTMENT

• The five forms you printed and completed
• Current insurance card
• Current photo ID
• Physician referral forms, if required by your insurance
• List of your current prescription and over-the-counter medications, with the dose and frequency of each one
• All relevant medical records–blood test results, x-ray reports and health care provider reports

ADDITIONAL INFORMATION

We kindly request that you arrive 5 minutes before the appointment time in order to allow the staff to complete your registration. The first appointment generally takes 2 hours.

If you expect allergy testing to be done at the first appointment, please do not take any antihistamine medication for at least 72 hours before your appointment. Antihistamine medications prevent the skin from showing a positive result. If you take any antihistamine within 72 hours of the appointment, testing may not be performed and a follow-up appointment would be needed. Do not stop taking any other medications. If either you start any new medications, or if an illness begins, during the 72 hours before your scheduled appointment, please call our office and let us know.

INSURANCE AND PAYMENT INFORMATION

If you have any specific questions regarding your health insurance coverage/benefits and referrals, you should contact your health insurance company and ask specifically about whether your coverage includes evaluation by an allergist and allergy testing.

If you have HMO or POS coverage through your health insurance company and you are required to have a written referral in order to be evaluated by us, you must confirm with us that our office received it before the appointment.

Your health insurance company may require a co-payment at the time of your appointment. You are required to pay any co-payment at the time of the office visit – according to the terms of your health insurance coverage and our contractual obligation with the insurance companies.

You are responsible for charges not covered by your health insurance. When necessary, we will work with you to set up a payment plan.

If you have any questions about either our billing practices or which insurance plans we accept or the costs for your appointment, please contact us at 847.579.4265.