Patient Forms

Thank you for choosing the Allergy and Asthma Center as your treatment facility. We have provided downloadable versions of all the necessary forms for you to begin treatment with us. Those forms include:

For telemedicine patients, at the TIME of your appointment, please go to:

• www.doxy.me/drallergist for your appt with Dr. Wasan or
• www.doxy.me/amyfeldmanpa for your appt with Amy Feldman, PA.

New Patient Forms

For New patients, please print and complete the two sets of forms below.

• New Patient Forms
• Telemedicine Patient Consent Form
• Antihistamines to Stop Five Days Prior to Appointment
• Release of Medical Information
• Information for Patients on Beta Blockers

Established Patients

• Follow Up Patient Form

Outside Shot Form

• Outside facility shot form
• Supervising Physician Form

Allergy Shot Forms

• Allergy Shots Consent Form
• Allergy Serum Remixing Form (for shot patients)
• Changing Allergist Form

Other Forms

• Food and/or Medication Challenge Instructions
• Patient Authorization for Communication