Patient Information

*** Important Message About Medications ***

What to Bring to Your Appointment || Insurance and Payment Information

Patient Forms || Our Notice of Privacy Practices

What to Bring to Your Appointment

• Your insurance card and identification
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medication, including dose and frequency
• Information about your medical and surgical history
• Recent skin test results or relevant records

Patient Forms

For your convenience, the following registration and questionnaire packets are available online for you to print out, complete and bring to your appointment.

• New Patient Registration (pdf)
• Registration Form (pdf)
• New Patient Questionnaire (pdf)

• Welcome New Patient!
  
• Important Message About Medications
  
  

[If you need assistance viewing the printer-friendly PDF forms, please click here for troubleshooting help.]

Insurance and Payment Information

Canton Asthma & Allergy is a provider for Medicare and most major insurance plans, and provides insurance billing. We participate with a wide range of PPO, HMO, and POS insurance plans. Please call our office for specific information regarding your particular insurance plan. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.