Allergy & Asthma Center, PC

(541) 485-0316

Patient Forms

We are pleased to offer you the opportunity to complete the forms on your computer (you can type directly onto the form), then PRINT THE COMPLETED FORMS and bring them with you to your appointment to help reduce your waiting time.

If you have any questions about these forms, please contact us at the practice directly.

[PDF Help]

  1. Initial Visit Instructions [PDF]
  2. Patient Registration Form [PDF]
  3. Patient Health History Form [PDF]
  4. Current Medications and Medical Problems [PDF]
  5. Acknowledgement of Receipt of Notice of Privacy Practices [PDF]
  6. Credit Policy [PDF]
  7. Authorization for Release of Medical/Health Information
  8. Hives Questionnaire [PDF]
  9. Patient Dermatology and Allergy History [PDF]
  10. Stinging Insect Sensitivity Questionnaire [PDF]
  11. Consent for Immunotherapy [PDF]
  12. Penicillin Evaluation [PDF]
  13. Medical Records Request Form [PDF]

To help reduce your waiting time, please read our privacy policy.