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Exton Allergy & Asthma Associates

Specialized in asthma, allergic diseases, and sinus disorders

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Contact Us

Located in Exton, PA

Serving Chester County and Beyond!

610-269-3066

We would be glad to discuss the services we offer

and answer any questions you may have.


Forms



Please download, print and complete the appropriate form(s)

before you come to your appointment and bring them along to our office:


For Returning Patients

Please review and complete this Form:

Follow-Up Questionnaire


For New Patients

Please review our Privacy Statement:

Notice Regarding Privacy of Personal Health Information


Please Print, Complete, and Sign the following documents:

 

1)  Patient and Insurance Information Sheet
2)  New Patient Questionnaire

3)  Acknowledgement of Receipt of Notice of Privacy Practices


For Our Asthma Patients

If you have been diagnosed with asthma, please also fill out one of the following three forms:

Asthma Control Test (ACT)   -  For Adults and Children Older than 12 Years of Age

Childhood ACT   -  For Children 4 to 11 Years of Age

TRACK (Under 4 Years of Age)  -  For Children under 4 Years of Age


For Our Eczema Patients

If you have eczema, please also fill out the ECZEMA ASSESSMENT:

Eczema Assessment


Other Forms

If you wish to transfer your medical records or any health-related information to us or from our office to another health care provider, please fill out the CONSENT FOR RELEASE OF INFORMATION and mail the signed form to us.

Consent for Release of Information

If you want us to provide instructions for the emergency management of food allergy to schools or camps, please download the Anaphylaxis Emergency Action Plan form, fill and sign it and bring it along to your appointment. You may also mail or fax it to us and we will complete the form, and direct it to where you wish it to be sent.

Anaphylaxis Emergency Action Plan

If you are considering allergy shots (allergen immunotherapy) and wish to know about more about this treatment modality, please read the INformation about Allergen Immunotherapy (Allergy Injections). Once you decide that you want to start allergy shots please print out the Consent to Receive Allergen Immunotherapy (Allergy Injections), fill it out and sign it, if you fully understand the information provided and have no further questions. You can bring the completed and signed consent form to our office, fax it or mail it to us. We will prepare your immunotherapy extract within one week after its receipt and notify you when you can start immunotherapy.

Consent to Receive Allergen Immunotherapy (Allergy Injections)


Committed to Excellence

* * * * *

Dedicated to Superior Patient Care

Copyright Exton Allergy & Asthma Associates | 656 West Lincoln Highway Exton, PA 19341 | 610-269-3066| Site map