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Patient Forms

Information for New Patients :

We welcome you as a new patient to the Allergy and Asthma Center of Austin.

Your new patient appointment will last 30 to 45 minutes. To help make your time with Dr. Howland or Dr. Lieberman more productive, we ask that you complete a Patient Information form and a 4-page medical questionnaire. (5 pages total)

Forms Needed for Your First Visit:

Please review our Privacy Practices and Financial Policy before completing

any forms.

Patient Information Form: Click Here to complete and print.  If you prefer you

can print and then complete the form.

New Patient Medical Questionnaire: Click Here print and then complete the form.

Other Items Needed for Your First Visit:

Your insurance Card

Referral (if required by your insurance company)

List of current medications

Please complete your paperwork and bring it with you to your appointment. These forms will become part of your permanent medical record with our office.  Please print them on clean, white paper for optimal legibility. For your convenience, the Patient Information Form can be completed on your computer and then printed or you can print it and complete it by hand.  The patient history form should be printed on four separate sheets of paper and completed.

Please arrive 15 minutes before your scheduled appointment time.  If you have not completed your paperwork, please arrive 30 minutes before your scheduled appointment time. We make every effort to see patients on time with little or no waiting. Arriving early with your paperwork completed helps ensure that you and other patients will be seen in a timely manner.

 

Information for Established Patients:

We ask that you update your information form annually to ensure we have your current demographic information and insurance information.

Patient Information Form: Click Here to complete and print.  If you prefer you

can print and then complete the form.

Other Items Needed for Your Visit:

Your insurance Card

Referral (if required by your insurance company)

List of current medications

 

 

(You will need to have the "Adobe Reader" installed to read and print this file-if you don't already have it on your computer you can use this link, which opens in a new browser window, to download "Adobe Reader" for FREE here.)