Forms

Please try your best to fill the following FILLABLE PDF forms electronically. Next print the forms and take with you for the appointment. 

Most patients tell me that other doctors take patient history in a different way. I appreciate that you understand my method of patient care.

 

I have helped thousands of patients. To help you, I need to understand your symptoms. I can get information from you in two ways:

 

  1. I ask you about your symptoms; you may reply in a hurry to save my time; I may misunderstand your answers. So, I will not get the comprehensive information.

  2. You take your own time and  write your symptoms in your own words; as you are not rushed, I will get more accurate picture of your medical problems.

 

Even during follow-ups, I will ask you to write your symptoms and your medications. I want you to write your medications rather than my nurse copying the information from the chart because you may be taking medications differently than what we prescribed.  

 

Thank you for your understanding and cooperation.

NEW PATIENT

(This also includes patients we have not seen for more than a year.)

Registration Form

New Patient Packet

Occupational History Form

HIPAA Form

SuperBill

Copy of Insurance Card (front and back side)

FOLLOW-UP VISIT / TELEMEDICINE VISIT

Vaccinations

  1. We recommend a flu shot to patients older than 6 months. The flu shot can prevent flare-ups of breathing problems, ER visits, hospitalizations and death.

  2. Experts recommend pneumonia shots for asthma, COPD, and other medical problems. The schedule for pneumonia shots is complicated. Please talk to your primary care physician or your pharmacist. https://www.cdc.gov/pneumococcal/vaccination.html and https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

  3. Other vaccines. Please talk to your primary care physician.

ABOUT DR. PATEL

Diplomate, American Board of Allergy and Immunology with fellowship at National Jewish Health, Denver

CONTACT US

540 E. Abriendo Ave., Suite D,

Pueblo, Colorado 81004

Phone: 719-542-7222

Fax: 719-937-5082

Email: help@pateloffice.com

© Ashok PC. 

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