Patient Forms & Policies | Allergy and Asthma Associates of the Fox Cities

Patient Registration Forms

Thank you for the opportunity you have given us to provide you with allergy and asthma diagnosis and care. In order to prepare for your visit, we are asking you to pre-register with us.

Please remember to bring the following with you when coming for your appointment:

Insurance card
Driver’s license or photo ID
Co-payment (Any insurance co-payment is due at time of service.)
Completed yellow Patient Information form, Patient Health History form and a complete list of your medications, including dosage.

Obtaining this information allows our office to focus on the areas of greatest concern to you at your visit. It also allows us to better assist you with the coordination of your insurance coverage. The initial evaluation and testing average approximately $700 – $2,000. Small children, usually 5 and under, may have a limited amount of testing due to their size, making the cost less. Therefore, we suggest that you verify your insurance coverage before your appointment. As a reminder, your appointment has been scheduled for:

Please register 30 minutes prior to your appointment time. This appointment may take 1-2 hours. During this time questions will be asked regarding your medical history and your allergy observations. The physical exam and history given will determine the amount of testing needed.

All patients under 18 years of age must be accompanied by a parent or guardian.

Please refrain from wearing any cologne, perfume and/or body lotion, as these are irritants and can cause problems for patients with breathing difficulties. Due to patients with food allergies, no food is permitted in the waiting room or exam rooms. In the best interest of all patients, we ask you to please respect these policies.

The enclosed Patient Instruction/Consent Sheet for Allergy Skin Testing is provided for your information prior to testing. Please review this sheet in preparation for your appointment. If you have any questions, please do not hesitate to call us.

ADULT REGISTRATION FORM

CHILD REGISTRATION FORM

Help Us Help you

When you pre-register, Allergy & Asthma Associates can complete your medical chart and have the
most comprehensive knowledge about your health before treating you.

Please register 15 minutes prior to your appointment time.

This appointment may take 1-2 hours. During this time, we will ask questions about your medical history
and your allergy observations. The physical exam and history given will determine the amount of testing needed.

When you arrive for your appointment, please bring the following:

Your insurance card
Your prescription card
A list of current medications
Your driver’s license or other photo ID

Co-payment (Any insurance co-payment is due at time of service
Completed yellow Patient Information form and Patient Health History form

Please note:

You may complete our online HIPPA compliant forms at any time prior to your appointment with us.

If you prefer to fill out your forms at the clinic, please arrive 30 minutes prior to your appointment time.

Get Directions to Our Appleton/Waupaca Offices

All patients under 18 years of age must be accompanied by a parent or guardian.

Please do not wear any cologne, perfume and/or body lotion, as these are irritants and can cause problems for patients with breathing difficulties. Due to patients with food allergies, no food is permitted in the waiting room or exam rooms. In the best interest of all patients, we ask you to please respect these policies.

If you have any questions, please call us.

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