(315) 701-9500
5229 Witz Drive
North Syracuse, NY 13212
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Forms

Click on the links below to download helpful and informative documents.
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Additional forms and policies
Consent to Authorize Treatment under 18yrs old
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Immunotherapy Financial Consent
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Serum Mailing Waiver
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Testing Policy
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NEW PATIENT FORMS
APPOINTMENT INSTRUCTION SHEET
If you have any questions prior to your appointment, please contact our office.   
315-701-9500
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FIDELIS INSURANCE only/ NO SHOW & CANCELLATION POLICY
FIDELIS INS No Show & Cancellation Form- "New patient forms" must be received in our office prior to an appointment being made.  
Thank you for your understanding.
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FINANCIAL POLICY
"New patient forms" must be received in our office prior to an appointment being made.  
Thank you for your understanding.
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NO SHOW AND CANCELLATION POLICY
"New patient forms" must be received in our office prior to an appointment being made. 
Thank you for your understanding.
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PATIENT REGISTRATION FORM
"New patient forms" must be received in our office prior to an appointment being made.  
Thank you for your understanding.
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ALL PATIENT FORMS
Fidelis Appointment Policy/Notice of NoShow & Cancellation Policy
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FINANCIAL POLICY
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HIPAA Notice of Privacy Practices Effective 9-23-13
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Immunotherapy Consent Sheet
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Immunotherapy Financial Policy
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Medical Record Release to our Office
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No Show and Cancellation Policy
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Patient Appointment Instruction Sheet
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Patient Registration Form
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Records Release to Another Provider
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TESTING POLICY
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PEANUT OIT PROGRAM
PEANUT OIT FINANCIAL POLICY
The Peanut OIT Financial Policy must be signed and returned to the office prior to scheduling a Peanut OIT  INITIAL appointment.  Thank you.
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Peanut OIT Interest Letter
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Registration Form
This Registration Form must be completed and returned to the office prior to scheduling a Peanut OIT INITIAL appointment.  Thank you.
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Office Hours
To view office hours and phone hours for the Allergy & Asthma Diagnostic Office click here
Driving Directions
To view driving directions to the Allergy & Asthma Diagnostic Office click here
Did You Know?
More than 70% of people with asthma also suffer from allergies.

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