Notice of Privacy Practices and Acknowledgement of Receipt of Privacy (HIPPA consent form)
All patients should read our Notice of Privacy Practices and Acknowledgement of Receipt of Privacy (HIPPA consent form). The forms may be downloaded and printed out if you need a paper copy. Please sign the Acknowledgement of Receipt of Privacy (HIPPA consent form) and bring it in with you at your visit.
Other forms
Patient Intake Form (Registration)
For new and returning patients with new information.
Immunotherapy Consent Form and Consent Form ST
Please fill out the Immunotherapy consent form and Consent Form for ST (Skin testing) if applicable.
Medical Records Release from SB Allergy
Please fill out the Medical Records Release and/or Medical Records Release from SB Allergy if applicable.
Medical Questionnaire and ROS Questionnaire
All new patients and patients being seen after a hiatus of a year or more need to fill out the Medical Questionnaire and ROS Questionnaire.
For your convenience, and to save time at the first visit, you may download, fill out, print, and sign the above forms where applicable from the website and bring them with you at the first visit.
All new patients need to fill out and sign:
If you wish, instead of downloading the forms, you may come 15 minutes early at your first appointment and fill out the forms at the office. They are available as paper forms which we will scan into the EMR.
We will also scan copies of your insurance card(s) and Driver’s License at first new patient visit, and whenever there is a change in your information. Often we will ask you for your cards and to fill out forms at the beginning of the year when insurances often change. We do not need and do not take social security numbers.
The above documents and forms are in Adobe Acrobat (pdf) format. You can download a free copy of Adobe Reader from Adobe.