Other Patient Forms

Fairfield County Allergy, Asthma, and Immunology Assoc

Authorization for Allergy Extracts (pdf)
Use this form to renew your allergy shot vials or to start allergy shots

Insurances We Take

Billing Information Form (pdf)

Preparing For Your Allergy Visit (pdf)
A list of medications to TRY to stop prior to allergy testing.
If you are unable to stop any of these medications please do
not cancel your appointment without speaking to your allergist first.

Routine Assessment of Patient Index Data (pdf)
This form is for rheumatology patients.
Please complete before visit.

Records Release From Another Doctor to FCAAIA (pdf)
Use this form to have records sent TO our office from another doctor.
You may send one copy to each office from which your are
requesting records.

Records Release From FCAAIA (pdf)
Use this form to have your records released FROM our office to
anywhere else. Be sure to sign at the bottom. You may drop the form
off, mail it, or fax it to us.

****Please note: Service charges/fees are subject to change****Please contact FCAAIA for any questions or updates.

****Please check the POSTS below frequently for updated office information****

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