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Information and Forms for New Patients

Allergy/Immunology Questionnaire

This form asks about your current and past health history. This needs to be completed before your visit as the doctor will review it with you at your visit. Please print it, fill it out and bring it with you.

Allergy Clinic New Patient Questionnaire

Sino-Nasal Outcome Test

This form asks about your allergy symptoms. This needs to be completed before your visit as the doctor will review it with you at your visit.

Sino-Nasal Outcome Test (SNOT-20) Form

Medications to Avoid

This information sheet lists the medications that must be avoided before allergy skin testing.

Medications to Avoid List

Involvement in Care Discussion Form

This form has two parts. If would like your doctor to be able to discuss your medical care with someone besides yourself, put their contact information in the chart in the top half of the form. In the bottom half of the form, indicate which form(s) of communication may be used to contact you.

Involvement in Care Disscussions Form

Questions About Health Care Costs

Please see UR Medicine’s Questions About Health Care Costs for more information about health care cost estimates, insurance, financial assistance and more.

Questions About Health Care Costs

Patient Bill of Rights

Please see the UR Medicine’s Patient Bill of Rights for this information.

Patient Bill of Rights

Patient Responsibilities

Please see the UR Medicine’s Patient Responsibilities for this information.

Patient Responsibilities

Rochester RHIO

At your new patient visit you will be asked to electronically sign the Rochester RHIO form. A copy is provided below for you to review prior to your visit.

Rochester RHIO Standard Consent Form