General Patient Forms
These are the core forms every patient completes at or before their first visit.
New Patient Registration Form
- Patient demographics (name, DOB, address, contact info)
- Emergency contact
- Primary care/referring physician
- Insurance details
Medical History & Review of Systems Form
- Past and current medical conditions
- Surgeries or hospitalizations
- Allergies
- Current medications and supplements
- Family history of lung/sleep disorders
- Smoking or occupational exposure history
Consent for Treatment & Privacy (HIPAA)
- Authorization to treat and release information for insurance purposes
- HIPAA privacy acknowledgment
- Permission to communicate via voicemail/text/email
Financial Policy & Insurance Authorization
- Responsibility for payment and co-pays
- Billing and insurance claim process
- Late/no-show policy
Pulmonary Care
Pulmonary Function Test (PFT) Consent and Questionnaire
- Patient’s effort ability and contraindications
- Recent smoking, bronchodilator use, or illness
- Consent to perform spirometry, lung volumes, diffusion testing, etc.
Oxygen Therapy Evaluation Form
- Oxygen saturation levels
- Home oxygen use and prescription
- Physician certification for durable medical equipment (DME)
Tuberculosis (TB) and MAI Screening Form
TB exposure history, travel history, symptoms (cough, night sweats, weight loss)
COPD / Asthma Control Questionnaire
Assessing symptom frequency, medication adherence, and trigger patterns
Sleep Medicine
Sleep History Questionnaire
- Sleep schedule and patterns
- Snoring, choking, or apnea episodes
- Daytime fatigue or insomnia
- Epworth Sleepiness Scale (ESS)
Sleep Study Consent Form
- Explanation of overnight sleep test or home sleep apnea test
- Risks, benefits, and patient responsibilities
CPAP/BiPAP Setup and Follow-Up Form
- Device settings, compliance data, and patient education
- Follow-up schedule for usage review
Sleep Hygiene & Lifestyle Questionnaire
Caffeine, alcohol, screen time, and stress habits affecting sleep
Ask Us if you have any question?
We’re here to help you breathe easier, reach out to our team for answers and guidance.