Pollen Counts

Patient Forms

New Patient Packet

Our New Patient Packet is a PDF file that contains all of the necessary forms and information you need.

Please complete all three forms ONLINE first, then print and sign. Bring all three forms with you to the first appointment.

New Patient Packet

The New Patient Packet contains all three Patient Information, General Health Questionnaire, Notice of Privacy forms.

NOTE: If you're looking for individual patient forms, you can find them below.

fwaac patient forms

Patient Information

Please complete the form ONLINE first, then print and sign. Bring the form with you to the first appointment.

Patient Information Form

General Health Questionnaire

Please complete the form ONLINE first, then print and sign. Bring the form with you to the first appointment.

Patient Questionnaire Form

Notice of Privacy

Please complete the form ONLINE first, then print and sign. Bring the form with you to the first appointment.

Notice of Privacy Form