Online Patient Support Center - Allergy Asthma Immunology of Rochester

Quickly and conveniently obtain forms from our office. To view the forms listed below, you will need Adobe Reader. You may bring or mail your completed forms to the office at the time of your visit.

Allergy patients: Antihistamines as well as some other medications can interfere with skin testing results and need to be discontinued for a period of time prior to your visit with us. Please refer to the Skin Testing Medicines Not to Take Form for more specific information.

You may download Adobe Reader for free at www.adobe.com.

	Release of Records
	Notice of Privacy Practices
	Financial Policy
	Practice Brochure
	Skin Testing Medicines Not to Take

If you currently have an appointment scheduled with one of our physicians, you may download the appropriate history form from the list below. Please use the criteria listed to assist you in downloading the proper form. Forms should be completed prior to your appointment date and time.

	Allergy Form	Drs. Condemi, Pulver, Deane, Quaidoo, Hartel, Kleiner - all ages Dr. Kubicka - 6 years and up
	Pediatric Form	Dr. Kubicka- up to 5 years
	Rheumatology Form *	Drs. Condemi, Deane, Quaidoo 18 yrs. and up
	Nasal Treatments Nasal Saline ENT Solution Upper Respiratory Infection	All physicians.
	Immunotherapy and Financial Consent	All physicians.

*Prior to being seen for a rheumatology consult, your PCP must send a letter stating why you need to be seen along with office notes and lab work.

Strong Memorial Hospital is our primary affiliation. We are also affiliated with FF Thompson, Highland Hospital and Park Ridge.

Given the ever-changing situation in health care coverage, navigating your health insurance policy may be challenging. Before your visit with us, please take some time to understand your policy. Your plan may require a referral from your primary care physician. You may have to meet a deductible before your insurance company pays, or have to pay a co-payment. Ultimately, you are responsible for understanding your policy, knowing what’s covered, and what your financial obligation will be. Please see our Financial Policy for further detail.

BILLING POLICIES

As a courtesy, we will submit claims to most insurance companies whether our providers participate or not.

Payment is collected at the time of service for self-pay patients.

Co-payments, deductibles, and co-insurances are collected at the time of service, as specified by your insurer and plan.

Please bring your insurance card at each appointment. If you fail to notify us of insurance changes, you will be responsible for the full charges.

We accept cash, check, MasterCard, Visa, and Discover. For your convenience, you may pay via our HIPAA-compliant patient portal at www.aair.info.

Our billing staff is available daily to answer general questions about your insurance policy, give estimates of charges, and assist you in keeping your account in good standing.

FEES

Please do not use your FSA/HSA cards to pay non-medical fees. They will not reimburse you.

A fee is assessed, as specified by your insurer and plan, if payment is not collected at time of service.

There is a fee for returned checks. After two returned checks, we will no longer accept checks from you.

There is a fee if you miss your scheduled appointment without notice or cancel with less than 24 hour’s notice.