Education/Resources
Patient Forms
When you schedule a new patient appointment with one of our physicians, you will be mailed a history form and other forms to complete or you may download them here. Please make sure to have them completed prior to your visit.
Please also review the list of medications that must be stopped prior to your appointment, as they can often interfere with testing. A copy of this list is below. Check with your prescribing physician to see if it is safe to discontinue your medications.
You will need to download Adobe Reader to view the forms below:
- Welcome Brochure
- Allergy Patient History Form (All ages for Dr. Hartel, Tricia Kolczynski, FNP-C, Jody Delaney, FNP-C, Emily Marris, PA)
- Immunotherapy and Financial Consent (All providers)
- Skin Testing Medicines Not to Take
- Release of Records
- Notice of Privacy Practices
- Financial Policy
- Patient Portal Consent
- Patient Information/HIPAA Consent Form
- Rochester RHIO Consent
- NYS Surprise Bill Disclosure
Affiliated Hospitals
All of our physicians have clinical appointments and admitting privileges at Strong Memorial Hospital as well as Unity and F. F. Thompson. They also have teaching appointments at the University of Rochester Medical Center. Our practice has been selected as a teaching site to train licensed physicians in the principles of Allergy, Clinical Immunology and Rheumatology.
Insurance Information
In the ever-changing state of health care coverage, navigating your health insurance policy may be challenging. Before your visit with us, please take some time to understand your policy. Your plan may require a referral from your primary care physician. You may have to meet a deductible before your insurance company pays your claim or you may have to pay a copay. Ultimately, you are responsible for understanding your policy, knowing what is covered and what your financial obligation will be. Please see our Financial Policy for further detail.
Billing Policies
- As a courtesy, we will submit claims to most insurance companies whether our providers participate or not.
Fees
- A fee is assessed, as specified by your insurer and plan, if payment is not collected at time of service.
- There is a fee for returned checks. After two returned checks, we will no longer accept checks from you.
- There is a fee if you miss your scheduled appointment without notice or cancel with less than 24 hours notice.
Resources
American Academy of Allergy Asthma & Immunology – www.aaaai.org
American College of Allergy, Asthma & Immunology – www.acaai.org
Allergy and Asthma Network Mothers of Asthmatics, Inc – www.aanma.org
Asthma and Allergy Foundation of America – www.aafa.org
American Partnership for Eosinophilic Disorders – www.apfed.org
National Eczema Association – www.nationaleczema.org
Food Allergy and Anaphylaxis Network – www.foodallergy.org
MedicAlert – www.medicalert.org
Families with Food Allergies – www.fwfa.org
Pollen count- https://www.facebook.com/Allergy-Asthma-Immunology-of-Rochester-206654116034341