Privacy Practices

This notice of our privacy practices describes how medical information about you may be used and disclosed and how you can gain access to this information.

New Patient Registration Forms.

Our Patient Registration Forms must be received by the office at least 24 hours prior to your initial appointment. You have a choice of how you would like to fill out our Patient Registration forms.

• You can use our HIPAA compliant On-Line forms.
• You can print our forms, fill them out by hand and FAX them to us.

We urge you to use our On-Line forms which should help the The Allergy Clinic to better serve your needs.

Complete Forms On-Line

Our On-Line Forms are designed to make sure that you provide us with all the information necessary to provide you with the best possible care and service.

Before You Begin

• Before you begin gather any information that you may need such as your Insurance Card.
• You will need Adobe Reader version 9.4 or higher.
• The final page of the form requires you to enter an email address so that we can notify you when we receive the completed forms.

Filling Out the Forms

• The required fields are outlined in red.
• The optional fields are outlined in blue. Some of the optional fields will be required based on other information that you provide.
• The final page of the form requires you to enter an email address so that we can notify you when we receive the completed forms.

Verifying and Signing the Forms

• The staff will present the printed forms to you on your initial office visit at which time you will have an opportunity to review and correct any errors in the information provided.
• After a final review of the forms by you and any corrections are made the forms will be reprinted. You will then be asked to sign the appropriate forms.

Click the link below if you would like to use our On-Line forms.

On-Line Patient Registration Forms

Complete Downloaded Forms By Hand

Forms completed by hand can either be printed and FAXed to the appropriate office using the fax cover sheet included in the set of forms or you can bring the completed forms with you on your initial office visit.

Click the link below if you would like to download the forms and fill them out by hand.

Patient Registration Forms By Hand