Forms

On behalf of all of us at Kentuckiana Allergy, we would like to welcome you to our practice.  On this page, you will find all of the forms and background information you need to get started with us.  Before your first visit, please take the time to print these documents and fill them in.  This will make your first visit go so much faster!

This Welcome Letter is your first step.  This document will walk you through all our practice’s policies and procedures, and let you know what to expect as a patient with our practice.

Welcome Letter

New Patient Forms

New Patient Registration

HIPAA New Patient Consent – Short Form

HIPAA New Patient Consent – Long Form

Disclosure Authorization

Kentuckiana Allergy Appointment Information

Financial Policies

New Patient History & Physical

Medical Records

Authorization to Release Medical Records

Established Patient Form

Follow Up Form

Antibiotic Policy for Respiratory Infections

Antibiotic Policy for Respiratory Infections

Penicillium vs. Penicillin

Penicillium the Mold vs Antibiotic