Established Patient Forms

Form Options and Instructions

Below are two options on how to fill out the form, please read each option.

Option One
Forms can be printed and hand carried.

Option Two
Forms can be filled out and submitted via e-mail IF Adobe Reader used on the computer or mobile device. If PDF opens in a new window, download the form and open it in Adobe Reader. After the form is downloaded to your device, open it with Adobe Reader. In the form you will see fillable areas highlighted in a light blue. Click within this area to add information.

Download Adobe Reader

Click here to download Adobe Reader
PDF documents on this page require Adobe Reader to view and to fill. You may obtain Adobe Reader for free from the Adobe website by clicking the icon. If you already have Adobe Reader installed on your computer, you do not need to install it again.

Prior to your appointment, please fill out the forms below and hand carry to every follow up visit. These forms will save time during our check-in process.

General

Respiratory Symptoms Pre-Visit Questionnaire

Asthma Patient

Pre-Visit Questionnaire Form

Pre-Visit Questionnaire 

Asthma Control Test

Child Asthma Control Test*
*CACT (To be filled out by all asthma patients 4-11 years of age)

Asthma Control Test*
*ACT (To be filled out by all asthma patients over 12 years of age)

Cystic Fibrosis (CF) Patient

Pre-Visit Questionnaire

Birth – 11 years of age

12 – 18 years of age

Primary Ciliary Dyskinesia (PCD) Patient

Pre-Visit Questionnaire

Birth – 11 years of age

12 – 18 years of age