Forms

New Patient Registration
Please complete one of the following New Patient Registration Forms

Miscellaneous

Medical Records Release
Allergen Immunotherapy Consent Form
Patient Disclosure
Permission To Treat A Minor
Telemedicine Informed Consent
OUR OFFICES
Chandler office
Gilbert/Mesa Office
Phoenix Office
San Tan Office

Please be sure to fill out all English Forms under all Sections

he following forms are available for download in PDF format: New Patient Registration, Privacy Disclosure, Acknowledgement of Receipt of Privacy Policies, Consent for Disclosure of Information, Authorization to Release Medical Records, and Consent Form. Filling out these forms prior to your appointment will expedite your check-in process and help us serve you more efficiently at your new patient appointment. Please click on the link to each form to download it to your computer. Download the FREE Adobe Acrobat Reader to open and print the forms.

New Patient Registration Form

Privacy Disclosure/Consent

**Please note that the Acknowledgment of Receipt and Consent for Disclosure forms should be brought to your appointment. You should read the privacy disclosure and retain a copy for your records before signing the Acknowledgment and Consent forms **

OUR OFFICES
Chandler office
Gilbert/Mesa Office
Phoenix Office
San Tan Office

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Telephones are answered from 8am – 5pm, Mon – Thurs
8am – 4pm, Fri

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Dear Arizona Allergy Associates Community,

We want to reassure you that we are taking all precautions to prevent the transmission of viral illnesses, including COVID-19. As always, our exam rooms and instruments will be sanitized between each visit and our waiting rooms will be sanitized regularly throughout the day. We are asking that all persons entering the offices wear face coverings. Additionally, please limit the number of persons presenting to the office; we ask that only one parent attends with a child and that additional siblings remain home.

As an extra precaution, we will not be seeing any sick visits or patients with fever or flu-like symptoms at present. We request that any allergy injection patients and/or patients with upcoming office visits reschedule if they have been in contact with someone with fever or flu-like symptoms.

If you suspect you may have a viral illness such as influenza or COVID-19 you should seek emergency care services or primary care services as we are unable to swab and test for these illnesses.

Finally, for all allergy injections patients: out of an abundance of caution and in order to limit your exposure to any viral vectors, we request that you limit close contact in waiting areas. At this time we will temporarily allow you to sit in your vehicle during your 30-minute wait. You will still be required to come in and have your arm read at 30 minutes or earlier if you are experiencing any reaction during your wait. We may also alter your shot schedule to limit your visits to the clinic temporarily.

Thank you for your understanding during these difficult times. These changes are temporary and we will keep you posted with any changes or additional information.