New Patient Forms

We are the only Michigan food allergy specialist. Treat and diagnosing allergy / allergies symptoms to milk, nuts, tree nuts, fish, shell fish, egg, wheat, soy, fruit, gluten. There is no cure for food allergy / allergies but we can train you how to live with a food allergy and be safe with. Only location in Oakland County, Michigan to specialize in Food Allergy. Patients from all cities in Michigan are welcome: West Bloomfield, Wixom, Franklin, Novi, Northville, Farmington, Birmingham, White Lake, Fenton, Brighton, Pontiac, Troy, Royal Oak, Oak Park, Clarkston, Livonia, Ann Arbor, Ypsilanti, Plymouth, Southfield, Walled Lake MI, Commerce MI, Waterford MI, Flint MI, Lansing MI. We teach you how to survive with food allergy and multiple food allergies. Food allergy recipe / recipes many times taste poor we are building a food allergy recipe sharing web site. I am the only allergist in Oakland County Michigan to specialize in Food Allergy. A food allergy Specialist can accurately diagnose and treated for food allergy. Food allergy is a sub specialty that most allergists do not have enough experience or training. Symptoms seen anaphylaxis, nausea, eczema, atopic dermatitis, rash, vomit, vomiting, hives, dizziness, light headed. We treat adults, kids / pediatrics for food allergies that resolve and life long allergy. We test for food allergy at our specialty clinic.

Please fax/drop off or mail
the New Patient Registration Form to us prior to your appointment, this will shorten the time it takes to check you in at your first appointment.

Do not forget to contact your primary care doctor if you require a referral.

New Patient Forms
Please print and complete these forms prior to your visit.

Choose one (both forms are the same)
(this will greatly shorten the time it takes to check you in at your first appointment)

New Patient Registration Form- easy to email form, type and save to your computer

New Patient Registration Form- Print then fax or drop off prior to your appointment

Print and bring with you to your appointment

New Patient Forms- Print and sign and bring to your appointment

Medical Privacy - National Standards to Protect the Privacy of Personal Health Information

HIPAA -Please read prior to your appointment.

New Patient Information -please print and read (what to expect with your first appointment and list of meds to stop)

Medication List - If skin testing or if an oral challenge is to be done, these medications need to be discontinued

For More Information Contact:

Allergy & Asthma Institute of SE Michigan
7010 Pontiac Trail, Suite B
Tel: 248-363-3232
FAX: 248-363-3455

We are also a full service allergy and immunology practice.
Visit www.AllergyAsthmaMichigan.com
We diagnose and treat infants, kids and adults with: asthma, eczema, allergic nasal symptoms, hay fever, allergic eye symptoms

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Last modified: 03/10/08

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