New Patients: forms we'd like you to fill out

        The following are the forms we ask you to fill out, or read and sign, when you come to the office.  You can save time and download them here.  To do that, you need Adobe Acrobat Reader.  Many of you have that program, but if not, you can download it for free by visiting this page: Adobe Web site.

Forms all patients need to fill out (except for chelation - please see below) :

1. Info1

2. Insurance info

3. Info2

4. HIPAA privacy statement

5. Payment acknowledgement

6. Provocation food testing

7. Symptom Summary

8. Drugs

9. History

10. Food History

If you are a female patient, you'll also need this form:

Female

If you are a male patient, you'll also need this form:

Male

Chelation patients: If you are coming in for chelation therapy only, you will need only to fill out forms 1-5 above, and you will also need this form - Chelation

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Copyright © 2005 Santa Fe Center for Allergy and Environmental Medicine
Last modified: April 08, 2006