Allergy and Asthma Care of Fairfield County
Food Allergy Center of Connecticut
Dr. Kenneth Backman • Dr. Irena Veksler • Dr. Katherine Bloom
Please click to download and then fill out both the patient information sheet and allergy history form below, and then bring them with you for your appointment. It is very important that these forms be filled out prior to your scheduled appointment time. The financial policy, and credit card on file policy forms are for your reference. Thank you.