Patient Information


 

Welcome To Advanced Allergy & Asthma

New patients, we value your time, to make your first visit as smooth as possible please print off and fill out the following forms:

New Patient Form

Patient Questionnaire 

Family Registration Questionaire 

Payment Agreement

HIPAA Notice of Privacy Practices

Arbitration Agreement 

Consent and Conditions of Treatments 

 

Required Patient Information:

  •  Your insurance card
  •  Physician referral forms, if required by insurance
  •  List of prescriptions and/or over-the-counter medication, including dose and frequency
  •  Information about your medical and surgical history
  •  Recent x-rays or relevant records

Online Patient Information

Advanced Allergy & Asthma offers online access to billing and medical information. Please note this will open in a new secure window.

Patient Portal 

Billing and Insurance

Advanced Allergy & Asthma is a provider for most major insurance plans, and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Location
Advanced Allergy and Asthma
4403 Harrison Blvd., Suite 4640
Ogden, UT 84403
Phone: 801-203-3308
Fax: 801-387-4855
Office Hours

Get in touch

801-203-3308