NEW PATIENTS: Download, Print, Fill out Forms

Allergy and Asthma Care of Fairfield County
Food Allergy Center of Connecticut
Dr. Kenneth Backman  • Dr. Katherine Bloom • Dr. Sara Dever •                                                           Jillian Ross, APRN • Nikki Carino, APRN

 

NEW PATIENT FORMS - DOWNLOAD, PRINT, AND FILL OUT BEFORE APPOINTMENT:

ALLERGY HISTORY FORM (CLICK HERE)

PATIENT INFORMATION SHEET (CLICK HERE)

 

Billing and appointment information for your first visit

Medications to avoid before allergy skin testing

What to expect from your visits

Financial policy

Credit card on file policy

Download Consent to Treat Minor (if not accompanied by parent)