Welcome, New Patient!

PLEASE BRING:

  • Photo I.D.
  • Insurance Card
  • Completed New Patient Allergy Evaluation Form (see below)
  • Completed Registration Form (see below)
  • Any pertinent medical records related to allergies, asthma, dermatology, or immunology that the doctor might find helpful.
  • Medication lists, photos, prescription bottles, or anything else that may be useful.

Your first appointment may involve testing or other requirements, so please plan on being in our office for approximately 1-3 hours.

 

If you cannot print and fill out the two required new patient forms below, you must arrive 20 minutes early for your appointment to fill them out in our office.

 

If you need to cancel or reschedule your appointment, please inform us at least 24 hours in advance. If you call after business hours, you can leave a message.

 

New Patient Paperwork

*Please print both documents below!*

1. Registration Form
Click the underlined .pdf link below to download the file and print.
-Fill out all the information that you can.
-Please remember to sign the bottom.
Patient Registration Form.pdf
Adobe Acrobat document [84.3 KB]
2. New Patient Allergy Evaluation
Click the underlined .pdf link below to download the file and print.
-Please fill everything out the best you can.
-Put "N/A" if not applicable and check "negative" if negative.
-You can stop at section K.
Allergy Evaluation Form.pdf
Adobe Acrobat document [160.1 KB]

 

Are You Taking Antihistamines?

If possible, please do not take any antihistamines for at least 5 days prior to your appointment as they interfere with possible allergy testing.

 

Examples:

*(Note: This is not a complete list)*

 

Prescription Medications

 

  • Hydroxyzine (Atarax, Vistaril)
  • Azelastine (Astelin, Astepro, Optivar)
  • Olopatadine  (Pazeo, Patanol)
  • Dymista
  • Cyproheptadine (Periactin, Peritol)
  • Promethazine (Phenergan)
  • Doxepin (Zonalon)

Over-The-Counter

  • Most over the counter “allergy” medications

  • Many over the counter "sleep aids"

  • Diphenhydramine (Benadryl)

  • Cetirizine (Zyrtec, Allertec)

  • Loratadine (Claritin, Alavert)

  • Desloratadine (Clarinex)

  • Fexofenadine (Allegra)

  • Levocetirizine (Xyzal)

  • Brompheniramine (Bromfed, Rondec, Dimetapp)

  • Chlorpheniramine (ChlorTrimeton)

  • Clemastine (Tavist)

  • Triprolidine

 

Note:  If you are unsure whether your medication qualifies as an antihistamine; you can check the medication bottle/pamphlet, ask your provider or pharmacist, check online, or call the office during our regular business hours.

 

 

Are You Taking Steroidal/Corticosteroidal Medication?

Please inform the doctor if you are currently taking oral steroidal/corticosteroidal medication, or if you have taken any in the past 4 weeks.

 

Examples:

*(Note: This is not a complete list)*

 

Prescription Medication

  • Prednisone
  • Prednisolone (Orapred, Prelone)
  • Hydrocortisone (Cortef)
  • Methylprednisolone (Medrol)
  • Dexamethasone
  • Bethamethasone (Celestone)
  • Triamcinolone (Aristocort)
  • Cortisone
  • Deflazacort (Emflaza)
  • Fludrocortisone (Florinef)

 

                                                                                                  Attention Asthma Patients!

If possible, we ask that you please try to NOT use your maintenance inhaler (example: Breo, Symbicort, Advair,on the morning of your appointment

This will help the doctor obtain a baseline if a pulmonary function test is required.  Thanks!

 

Copays are due at the time of the visit.

 

We accept:

Health Privacy
Click here to view a notice regarding the privacy of your personal health information.
Notice Regarding Privacy of Personal Hea[...]
Adobe Acrobat document [125.2 KB]