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New Patients

Everything you need before your first appointment.

Welcome!

We’re looking forward to meeting you.

To help make your first visit as smooth as possible, please complete the appropriate forms before your appointment. Most patients can finish their paperwork in approximately 10-15 minutes.

If you have any questions while completing your forms, please contact our office, and we’ll be happy to assist you.

Before Your Appointment

Please have the following available before completing your forms:

  • Photo ID
  • Insurance Card
  • Current Medication List
  • Referring Physician Information (if applicable)
  • Recent imaging or test results (if available)
  • Previous sleep study or CPAP information (Sleep Medicine patients)

Pulmonary New Patient Forms

For patients being seen for asthma, COPD, chronic cough, shortness of breath, lung disease, or other pulmonary conditions.

Estimated Time:

10-15 minutes

    Past Medical History
    AsthmaCOPDBronchitisPneumoniaTuberculosisPositive TB Skin test (PPD) Lung SurgeryHeart SurgeryOther Surgeries PenicillinSulfa DruglodineAspirin
    Social History
    Yes, currentlyNo, I have never smokedYes, but I quit No, neverDailyWeeklyLess frequently No, neveryes, currentlyYes, but in the past
    Occupational History
    WorkingRetiredUnemployedDisabled Coal dustChemical fumesSilica dustAsbestosPaint spraysCaged Birds AsthmaEmphysemaLung cancerOther lung diseaseOther cancer
    Current Medication List
    Medication How Strong How Often
    Select Other Side Effects
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    Sleep Medicine Questionnaire

    For patients being evaluated for sleep apnea, snoring, insomnia, excessive daytime sleepiness, CPAP concerns, or other sleep disorders.

    Estimated Time:

    10-15 minutes

      Epworth Sleepiness Scale
      Sitting & reading
      Watching TV
      Sitting, inactive in a public place like a theatre, a waiting room, or a meeting
      As a passenger in a car for an hour without a break
      Lying down to rest in the afternoon when circumstances permit
      Sitting and talking to someone
      Sitting quietly after lunch without alcohol
      In a car, while stopped for a few minutes in traffic
      Cardiac

      Medicare Patients

      If you are covered by Medicare, please review and complete the required Medicare Open Payments Notice before your appointment.

        Notice:

        The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

        For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

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