New Patient Forms

Thank 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.

New patient forms can be filled online and submitted to us securely.

 New Patient Forms 

Printable forms

PDF version that can be printed, filled and returned to us by mail, faxed (847) 888-8802 or dropped at any of our locations.

New Patient Forms

If you do not have a compatible program, please click the icon to download the free adobe reader.

Dermatologist in San Antonio

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 (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.
Please note: There is a $25 – $50 cancellation fee for appointments not cancelled 24 hours prior to your visit.

*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
Cetirizine Zyrtec 4
Clemastine Allerhist-1,Contac-Allergy, Tavist 7
Cyproheptadine Periactin 8
Desloratadine Clarinex 5
Diphenhydramine Benadryl/Waldryl and others 1
Doxepin (stop only if prescribing Dr approves) Sinequan 3
Famotidine Pepcid 2
Fexofenadine Allegra 4
Hydroxyzine Atarax and others 3
Levocetirizine Xyzal 5
Loratadine Alavert/Claritin 3
Monteleukast Singulair 2
Olopatadine Hydrochloride Patanase Nasal Spray 1
Promethazine Phenergan 3
Ranitidine Zantac 2
Acrivastine, Brompheniramine, Chlorpheniramine, Promethazine, Pyrilamine Tannate, Tripelennamine READ INGREDIENT LIST of over the counter allergy and cold medications 3

Our Happy Patients

Many Patients are satisfied and even ecstatic with the abilities of Dr. Askenazi and
the team at Advance Allergy & Asthma Associates.

National Allergy Bureau Pollen and Mold Report.