Dear Patient,

Please print and complete the New Patient Registration Form and New Patient Questionnaire and bring them with you at the time of your first visit. The initial visit may include skin testing in addition to a detailed history and physical examination. Because of limited space and the time involved, please do not bring small children, other than the patient, to the office for the initial visit.

A number of medications can affect skin test results and must be discontinued for a specific amount of time to allow for proper interpretation of allergy skin tests. Please refer to the List of Medications page and follow the timeline suggested for each. As a rule, asthma medications do not affect skin tests and can be continued as prescribed.

If the patient is a minor, we will need a parent or legal guardian with proof of guardianship to accompany them to their appointment. If any other relative brings the minor patient, they must present signed permission with a copy of the parent or guardian's driver's license. It is the policy of this office that the parent/guardian bringing the child must be prepared to pay any copayments at the time of the appointment.

Before your appointment:

• Call your insurance company to verify your coverage and ask:
  Does my insurance cover skin testing?
  Does my insurance have a deductible that needs to be met before they pay?
  Does my insurance require me to pay an office visit copay or percentage?
• If you have HMO insurance, obtain a written referral from your doctor.
• Call our office 2 days before your appointment to verify that we have received your referral.
  Without the authorization form, you will be asked to reschedule or pay for all charges at the time of your visit.
• Read and follow the timeline for medications needing to be discontinued.
• Complete your registration form and questionnaire before you arrive.

• Arrive 10 minutes before your appointment.
• Bring your completed forms and any records from your physician.
• Bring your insurance card(s) and a driver's license.
• Bring payment method for your copayments (if you ask us to bill you, there will be a $10.00 statement fee added to your charges)
• If the patient is a minor, a parent or legal guardian with proof of guardianship records must be present.

Cancellations on the day of your appointment or a broken appointment with no notification will result in fees charged for unused time and possible denial of future appointments.

Sincerely,
David H. Seaman, M.D.
Steven V. Stryk, M.D.