New Patient FormsThank you for choosing us to participate in your healthcare. We look forward to caring for you and/or your family. Our providers are trained and experienced in the treatment of both children and adults.
We strive to make your visit a pleasant one, and attempt to arrange our schedule to minimize your waiting time. Therefore, we respectfully request that you notify us as soon as possible if you are unable to keep your scheduled time. Please note that a minimum of 24 hours of notice is required to avoid the $25 - $50 cancellation fee.
We will verify your eligibility, deductibles, co pay & co insurance prior to your appointment. We highly encourage you to call to verify your own allergy benefits along with any limitations you may have on your policy. A link to our complete financial policy can be found below and should be read before presenting for your appointment.
In order to improve your patient experience we ask that forms be filled and returned to our office prior to your appointment. This will enable our staff to prepare ahead for your arrival.
Before choosing form fill option please review the following policies.
Please click here to view our financial policy.
Please click here for our HIPAA policy.
New patient forms can be filled online and submitted to us securely. Click on this link to get started New Patient Forms In case of technical difficulty, click here for PDF version that can be printed, filled and returned to us by mail, faxed (866) 246-1164 or dropped at any of our locations.
If you do not have a compatible program, please click the icon to download the free adobe reader.
Click here to download it.
Please use the checklist below to insure you will have all the information the doctor will need for your initial evaluation. Click here to print
- If able, please discontinue use of all anti-histamines prior to your appointment. *SEE TABLE
- Please print and fill out the paperwork found within the links on this page and fax or email the information to us prior to your appointment. If you are unable to fill out the forms ahead of time, please arrive 15 minutes before your appointment to complete. Fax 866-246-1164 or email email@example.com (must save as a document, it will not e-mail from our website)
- Bring with you your drivers license or identification card, insurance card, and co-pay.
- Bring all prescription drugs and over the counter medications you take (including herbal supplements).
- Bring, address, and telephone number of your primary care physician or referring doctor.
- Bring a copy of any recent laboratory work, allergy testing, CAT scans, X-Rays, or MRI’s related to the condition we are seeing you for.
*The following medications contain anti-histamines CHECK THE GENERIC NAME OF ALL YOUR MEDICATIONS as they can interfere with allergy skin testing. The column on the right indicates the number of days that the medication should be stopped prior to your office visit unless stopping it will worsen your condition. If physician prescribed, check with your doctor to see if it is safe to stop this medication.
|Generic Name-Read Label||Brand Name||Days to be off med prior to test|
|Azelastine||Dymista, Astelin & Astepro, Nasal Spray||1|
|Diphenhydramine||Benadryl/Waldryl and others||1|
|Doxepin (stop only if prescribing Dr approves)||Sinequan||3|
|Hydroxyzine||Atarax and others||3|
|Olopatadine Hydrochloride||Patanase Nasal Spray||1|
|Acrivastine, Brompheniramine, Chlorpheniramine, Promethazine, Pyrilamine Tannate, Tripelennamine||READ INGREDIENT LIST of over the counter allergy and cold medications||3|
Advanced Allergy & Asthma AssociatesDr. Noga Askenazi | Dr. Eugenia Hahn | Meredith Cirrincione
Dr. Noga Askenazi is a nationally recognized asthma and allergy specialist who is board certified in pediatric and adult allergy. Her areas of special interest are innovative treatment of rashes, sinusitis, food allergies, asthma and immune disorders. She was past President of the ISAAI (Illinois Society of Allergy, Asthma, & Immunology), works on state and national committees for advancement of the allergy field and is a consultant for Advocate, AMITA, Northwestern amongst other health care systems. Her joy is helping patients reach their goals after together determining best treatments. Her staff and patients are a chosen family, and she invests in their happiness. She enjoys gardening, biking and cooking to good music.
Dr. Eugenia Hahn is a highly recognized board certified allergist and immunologist who treats patients of all ages. Her areas of special interest are food allergy, eczema, and asthma. She is president of the Illinois Society of Allergy & Asthma, a National Committee leader of the American Academy of Allergy, Asthma, and Immunology, a member of the American College of Allergy, Asthma, and Immunology working on new treatment options for patients. She is a consultant for Advocate, Northwestern, AMITA, Northwest Community healthcare systems amongst many others. Her patients mean everything to her as she takes pride in finding the why behind the problem. She enjoys reading and spending time with her family.
Meredith Cirrincione is a board certified Physician Assistant and specializes in treating allergies, with a focus on asthma, rashes, environmental allergies, chemical and food allergies. She holds a Masters in Physician Assistant Studies from The Chicago Medical School - Rosalind Franklin University of Health Sciences. She is a Fellow member of the American Academy of Physician Assistants, the Illinois Academy of Physician Assistants, and the Association of PAs in Allergy, Asthma and Immunology. She likes to approach things holistically. She is a strong patient advocate and adored by her patients. She enjoys singing, reading, cooking, and the great outdoors.