(765) 802-1433
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Forms
New Patients
New Patient Questionnaire (updated 7-30-25)
Release of Information (ROI) Form
- to
request previous records
Your New Patient Visit
Preparing for Skin Testing
Established patients
Patient Portal & Payments
Allergy Shots (SCIT/AIT) Consent Form
New Vial Consent
ILIT Consent Form
SLIT Consent Form
Consent to Treat Minors without Parent Form
- with another adult present
Consent for allergy shots without a parent present
- f
or minors/teenage drivers
Release of Information (ROI Form
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to allow us to send your records elsewhere
Phone: (765) 802-1433
Fax: (765) 802-1434
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Kokomo Office
2216 W. Alto Road
Kokomo, IN 46902
Office Hours
M/Th 8 AM-12 PM, 1 PM - 4:30 PM
W 8:30 AM - 11:30 AM
Closed for lunch 12-1pm
Shot Hours
M/Th 8:10 AM- 11:20 AM; 1:00 PM- 4:10 PM,
W 9:10 AM- 11:20 AM
Westfield Office
17600 Shamrock Blvd. Suite 1403
Westfield, IN 46074
Located on the first floor of the Riverview Westfield Hospital
Office Hours
T/F 8 AM - 12 PM, 1PM - 4:30 PM
Closed for lunch 12-1pm
Shot Hours
M/Th 8:10 AM- 11:20 AM; 1:00 PM- 4:10 PM,
W 9:10 AM- 11:20 AM
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