Dr. Jeffrey M. Bruner
John Frith

Allergy Information
New Patient Forms
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Asthma Allergy Institute of Michigan

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New Patient Forms
Please print and bring in these forms
 


 

Patient Information and Registration

 

Medications
  New Patient Checklist
  New Patient Questionnaire
  Hives/Urticaria/Angiodema (complete if reason for treatment)
  Insect Allergy (complete if reason for treatment)


Information to be reviewed

   

 

Frequently Asked Questions
Insurance/Costs/Codes
 

 

Injection Hours
After Hour Calls
 
  Medications to Avoid  before testing
 
  Patient Financial Policy
 
  Privacy Practice Policy
 
  Records Release Authorization
 

Forms available in PDF format. 
Adobe Reader required to view

Click here to download from Adobe
 

 

 

Hospitals affiliated with:
 

Hospital Affiliations
 
 
 

 
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The Asthma & Allergy Institute of Michigan is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any information contained within the site. While the information contained within the site is periodically updated, no guarantee is given that the information provided in this Web site is correct, complete, and up-to-date.

Although the Asthma & Allergy Institute of Michigan Web site may include links providing direct access to other Internet resources, including Web sites, the Asthma & Allergy Institute of Michigan is not responsible for the accuracy or content of information contained in these sites.

Links from the Asthma & Allergy Institute of Michigan to third-party sites do not constitute an endorsement bythe  Asthma & Allergy Institute of Michigan of the parties or their products and services. The appearance on the Web site of advertisements and product or service information does not constitute an endorsement by the Asthma & Allergy Institute of Michigan, and the Asthma & Allergy Institute of Michigan has not investigated the claims made by any advertiser. Product information is based solely on material received from suppliers.
Asthma & Allergy Institute of Michigan

42607 Garfield
Clinton Township, MI 48038

586-286-9010
(fax) 586-286-7910

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