Allergy & Asthma Medical Group of the Bay Area, Inc.
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Immunotherapy Maintenance Reward Program for New Patients

Reach 'maintenance level' with your allergy injections and receive your choice of an iTunes gift card, a Target gift card, or two movie tickets! Speak with a physician or nurse to learn more information."

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Patient Forms



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For patients new to our practice - please download and complete all 5 pages prior to your visit. Be sure to bring these completed forms to your appointment and please arrive 30 minutes prior to your scheduled appointment time.

We also request that you bring any relevant medical records with you, such as hospital records, previous allergy testing, radiology and/or laboratory results.

Please be aware that we treat patients with severe lung disease therefore please arrive unscented..

Important note: If allergy skin testing is to be done at your initial visit, oral antihistamine medications must be discontinued 5 days prior to the appointment date. However, if your condition is bothersome enough to prevent you from stopping antihistamines for the suggested time period, we ask that you still keep your scheduled appointment - we can help speed your recovery now, and perform testing at a later date.

Form One: New Patient Registration (If 18 years or older)
Please print and fill out the New Patient Registration Form (downloadable PDF document)

Form Two: Minor Registration Form (If younger than 18 years old) Please print and fill out the Minor Registration Form
(downloadable PDF docuument)


Form Three: New Patient Questionnaire and Medical History (All Patients)
Please print and fill out the New Patient Questionnaire and Medical History Form (downloadable PDF document)

Form Four: Minor Consent to Treat Form
Please print and fill out the Minor Consent to Treat Form only if someone other than the legal parent or guardian is bring the patient in for their appointment (downloadable PDF document)

 

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