Little Rock: 10310 W. Markham St. Ste 222, Little Rock, AR 72205 | Conway: 400 Salem Rd, Ste 4, Conway, AR 72034
(501) 227-5210 | 1-800-256-5844 (TOLL-FREE)
 

For Patients

We’re here to help!

If you need information about your upcoming appointment, or simply want to learn more about the treatments we offer, browse our Patient Info section.

Based on our core values of Education and Customer Service, it’s our goal to offer you the resources needed to live a healthy, symptom-free lifestyle.

Forms

New Patient?

Print and complete these forms and bring them to your first appointment
Notice of Privacy Practices (1.1 MB)
Receipt of Privacy Practices (37.0 kB)
Financial Policy (94.2 kB)
Pre-Registration Form (303.5 kB)
Patient History Questionnaire (226.7 kB)
Immunotherapy Consent Form (273.0 kB)
PT Immunotherapy Information (383.7 kB)
Authorization to Release Health Information

Receive Your Injections in Another Physician’s Office?

Print and complete this form and mail or fax it to our Little Rock office
Extract Order Form 2016
Venom Order Form 2016

Referring a Patient?

Print and complete this form and fax it to our Little Rock office
Referral Form (276.5 kB)

Flu Shot Paperwork

Informed Consent
Registration, Financial Consent, Financial Policy 2014

What To Bring

If you’re a new patient, we’re so glad you’ve trusted us with your care.

Be sure to bring:

  1. New patient paperwork
  2. Current insurance card(s)
  3. A form of payment
  4. And if you’re receiving allergy testing, please stop antihistamines 3-5 days before your appointment date

If you’re an existing patient, thank you for your loyalty!

Be sure to bring:

  1. A current list of medications
  2. Current insurance card(s)
  3. A form of payment
  4. And if you’re receiving allergy testing, please stop antihistamines 3-5 days before your appointment date