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Jack R. Eades, M.D. and Wasil Khan, M.D., Ph.D.
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Prospective Patients

 

To our newest patients at Southern Allergy & Asthma, P.C.:

We would like to welcome you to our office and thank you for considering us in receiving the best care in the Coastal region for your allergy needs. At Southern Allergy & Asthma, all patients are guaranteed to be seen by a physician who is accredited, fellowship-trained, and American Board of Allergy and Immunology certified. Below you will find the new patient forms available for download in pdf format. These forms are available to save you time during your initial visit. Please print and fill out prior to your appointment, and remember to bring the completed forms to your appointment.

Thank you for becoming a part of our Southern Allergy & Asthma family!

 

New Patient Information Form

Patient Guarantor Information Form

Patient Health History Form 1 of 2

Patient Health History Form 2 of 2

HIPAA Form

 
 
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