Other Forms

Authorization To Come Alone

Allergy Shot Consent Form

Authorization To Come With Another Adult

Shot Info Pack

Medical Records Forms & Information

  • Medical records will be sent to other physicians at no cost to patients after obtaining a valid medical record release form from the patient.
  • Patients requesting copies of medical records for personal use will be charged a copying fee of $1.00 per page for the first 25 pages copied, then $0.25 for each additional page. Payment is required prior to records being released.
  • Allow up to 2 weeks for copies of records.

Release Medical Records To Us

Release Medical Records From Us

Patient Form Completion Fees

  • School Medication Forms and Treatment Plans: NO CHARGE
  • Permanent Disability Forms: $75.00
  • Short Term Disability Forms: $50.00 (includes completion of FMLA, as well as any required records and follow up forms related to this incident.)
  • FMLA Paperwork: $35.00
  • Letters: $25.00
  • Other Forms: Call office

Patient must be current on office visits for forms to be completed. Please allow up to one week for pickup of completed forms.

Request an appointment

Note: this form is NOT sent over an encrypted connection. Do NOT send HIPAA protected information using this form. If your matter is urgent, please call our offices at 407-380-8700

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It's Time to Do Something About Your Allergies!

Your treatment will be performed by an expert Allergist. Schedule your appointment now!

It's Time to Do Something About Your Allergies!

Your treatment will be performed by an expert Allergist. Schedule your appointment now!