Like anything else in life, time taken ahead to prepare for your appointment will pay rich dividends and make your visit a fruitful and happy one.
Please prepare for this by bringing:
Health Insurance Card/Information
Photo ID or Driver's License
For minors, a written permission for evaluation and treatment from a parent or legal guardian if one of them is not accompanying the child
A list of medical conditions that you are afflicted with (current and past)
A list of all medications you are taking names, doses, and frequencies - REMEMBER TO INCLUDE ALL OVER THE COUNTER MEDICATIONS, VITAMINS, HERBAL PRODUCTS AND NUTRITIONAL SUPPLEMENTS
A list of drug allergies-Names, Dates and types of reactions
A list of surgeries, hospitalizations and ER or urgent care visits with dates and reasons
A list of your questions /concerns pertaining to your visit
Copies of medical records that are relevant to your visit from your family physician or other specialists - Include hospital records, Office visit notes, lab test results, previous allergy evaluation reports, biopsy reports, x-ray, CT or MRI reports or any other pertinent information
Names, phone numbers and fax numbers of doctors you would like us to send our initial consultation and follow up evaluation reports and from whom we need to get your medical records
Also remember to do the following: Wear appropriate dress that makes it easier to do physical examination; Strictly avoid wearing perfumes or strong scented skin and body care products on the day of appointment in the consideration of other allergy sufferers.
You can now make payments on your account using your VISA or MasterCard, If you want to take advantage of this new service, please complete the bottom half of this form and return it to us along with the top portion of your statement in a stamped envelope.
Please read Introduction to our office to better understand our philosophy and policies. Please read Notice of Privacy Practices to understand your rights under HIPAA law. You can find these forms by clicking the Forms Download Center button above.
Please click the Forms Download Center button, agree to our terms and conditions, then you may print new patient registration form by choosing the download forms button. You may complete the patient registration electronically by choosing the patient registration button.
If you choose to download and print the forms you may also fax them to (Kingman office) 928-681-5801 or (Bullhead office)928-758-2266.
You can also mail the forms to our office or bring with you at the time of your appointment. This will speed up your evaluation and treatment.
