THE WILLIAM STORMS ALLERGY CLINIC © 2016  | PRIVACY POLICY

Phone:       719-955-6000

Toll Free:   866-615-3885

Fax:            719-955-9595

 
 

Patient Forms

Please arrive to the clinic at least 30 minutes prior to your scheduled appointment. This is extremely important as you will need to sign additional forms and we will need to make a copy of your insurance card.

 

Please print the following pertinent forms, fill them out and return them to our clinic at your appointment or you may also fax them to us at 719-955-9595.

 

 

 

 

 

New Patient Packet:

Information for new patients about our office and what you can expect.

New Asthma Center Patient Packet:

Information and forms for New patients at our Asthma Center.

Medical History Release Form:

Authorization to Receive or Release Medical Records.

In-Office Extract Reorder Form:

Allergy extract (antigen) reorder form for current patients.

New Cough Center Patient Packet:

Information and forms for new patients at our Cough Center.

Insurance & Yearly Update Form:

Must be filled out for change of insurance and yearly updates.

New Allergy Shot Patient Forms:

Information and forms for allergy shot patients.

Mail out Extract Reorder Form:

Mailout allergy extract (antigen) reorder form for current patients.