Support & Forms
We care about our patients and servicing them better. Our Online Patient Service Center is a convenient alternative to interacting with our practice.
If you currently have a new patient appointment scheduled with one of our physicians, you will be mailed a history form and other forms to complete or you may download them here. Please check with our office to be sure you are downloading the appropriate forms if you have any questions after using the criteria listed to assist you. Please bring your completed forms with you to your appointment. Allergy patients: Antihistamines and some other medications can interfere with skin testing results and should be discontinued for a period of time prior to your visit with us. Please refer to the Medications to Avoid Prior to Skin Testing form for more specific information and check with your prescribing physician to see if it is safe for you to discontinue any medications.
You will need to download Adobe Reader to view the forms below.
- Patient Portal Consent
- Release of Records
- Notice of Privacy Practices
- Financial Policy
- Practice Brochure
- Skin Testing Medicines Not to Take
If you currently have an appointment scheduled with one of our physicians, you may download the Practice Brochure, Financial Policy, and Medications to Avoid Prior to Skin Testing from the list above as well as the appropriate history form from the list below. Please use the criteria listed below to assist you in downloading the proper form. Forms should be completed prior to your appointment date and time.
- Allergy Form (Drs. Condemi, Pulver, Hartel; Dr. Kubicka- over 6 years)
- Pediatric Form (Dr. Kubicka- up to 5 years)
- Nasal Treatments (All physicians)
- Nasal Saline
- ENT Solution
- Upper Respiratory Infection
- Immunotherapy and Financial Consent (All physicians)
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.
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.
- As a courtesy, we will submit claims to most insurance companies whether our providers participate or not.
- 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.