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Patient Forms

To make an appointment please call 251-304-0042. Please let us know if you would like to be seen in the Mobile or Daphne office. To help expedite your registration process you can now download and print our patient information forms. You can also call our office and request these forms to be mailed to you when you make your appointment with us. Please fill out these forms and bring them with you to the office. We will also require a copy of your insurance card. You may need to sign additional papers depending on the type of insurance that you have. If you require a referral from your insurance company, we will need a referral number or letter from your physician for our records. The referral can be brought in on the day of your visit or faxed to our office at 251-304-0262 prior to your visit date. If you have any questions, please call our office at 251-304-0042.

Patient Administrative History Form
This form requires your name, address, and insurance information.

Health Questionnaire
This is a detailed form regarding your history and your family history of allergies and allergy symptoms. It also requires an in-depth history of your environment.  This form is necessary to help Dr. Caputo determine the cause of your allergies.

Patient Portal Signature Authorization Form

Patient Consent

Electronic Prescribing

Rx History & Benefits

Electronic Radiology & Laboratory



 

 


Patient Informataion:

New Patient Introduction

Available Services at AAI

Methods of Payment

Patient Forms

 

 

 
Patient Administrative History Form©2016, Asthma & Allergy Institute - All Rights Reserved