Forms

Lebauer Allergy & Asthma

We Are Committed to Your Health

If you live in Greensboro, NC and are suffering from allergy or asthma symptoms, LeBauer Allergy & Asthma is here to help. We specialize in treating both seasonal allergies, such as pollen allergies, and food allergies, such as peanut allergies. Schedule an appointment with us today for allergy testing, allergy shots, and general environmental allergy solutions in the Greensboro area. Our team is dedicated to helping patients live a happier, healthier lifestyle. Please explore below to learn more about appointment scheduling, prescription refills, privacy rights, and other patient resources or feel free to give us a call for additional information.

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Appointments

Appointments to see one of our physicians can be scheduled by calling one of our locations. Our appointment schedulers will do their best to make your appointment time as convenient for you as possible.


Our appointments are generally in high demand. As a courtesy to other patients who may also want to see our physicians, please attend your scheduled appointment. If for any reason you are unable to keep your appointment at the scheduled time, please notify us at least 24 hours in advance so that we may offer that time to another patient. We also ask that you make every effort to be on time for your appointment.

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Prescription Refills

If you need to have a prescription refilled please call your pharmacy. They will call LeBauer Medical Center to authorize your refill. Please make prescription refill requests Monday through Friday during normal business hours. This will help ensure a timely response to your request. Refills for controlled substances or narcotic medications will not be refilled after hours or on weekends.


Please be aware that it is our policy to require annual office visits in order to continue to refill prescriptions. You may want to schedule yearly visits in advance to avoid any delays in refill requests.

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Release of Medical Information

Your medical records contain private information. We respect your right to privacy and will not give out any information regarding your medical condition to anyone without your permission unless required or allowed by law.



Once a Medical Records Release Form is signed by you, we are required to share all medical information with the individual or organization that you specify.

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HIPAA

The first-ever federal privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers took effect on April 14, 2003. Developed by the Department of Health and Human Services (HHS), these new standards provide patients with access to your medical records and allow you to have more control over how their personal health information is used and disclosed. They represent a uniform, federal floor of privacy protections for consumers across the country. State laws providing additional protections to consumers are not affected by this new rule.


LeBauer Allergy and Asthma makes every effort to comply with this complex set of requirements. Certain aspects of the law may be a bit inconvenient for our patients. However, they are enforced for your protection.

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Patient Rights

LeBauer Allergy, Asthma, and Sinus Care respects the basic rights of our patients. We believe that if an individual has sought out our services, they have expressed confidence in our ability to help alleviate their condition and provide optimal care for them. We express their basic rights as:


  • The right to impartial assessment
  • The right to receive considerate and respectful care
  • The right for independent decisions and action
  • The right for personal dignity


We ask that our Patients respect our staff, physicians, and other patients at all times. Please call 282-2300 with any concerns.

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Patient Accounting

We make every effort to keep our fees as fair as possible.  We participate with a variety of managed care plans in our community. If you have specific questions regarding your policy, please call your insurance company or our office.


It is our policy to collect co-payments at the time of service, we hope you understand and will be prepared at the time of your visit. For your convenience, your co-payments and any remaining patient balance can be paid by cash, check, Visa, MasterCard or American Express.


We will do our best to work with you and your insurance carrier to arrange for payment. However, please remember that payment for services is ultimately your responsibility.

NEW PATIENT FORMS 

Below you will find the New Patient Forms. We suggest that you take your time filling it out and just bring it with you when you arrive for your first visit. Please arrive a few minutes before your appointment, so that we can take your forms and put it in the computer to create your personal file.


If you are coming as a patient, please print and fill out the following form:

If you are coming as a parent or guardian for the patient, the following form will be needed.

MEDICAL RECORDS RELEASE FORM

If you need you need your medical records released to our practice or from our practice, please use the following form to authorize the release.

VACCINE RELEASE FORM

If you need your vaccination records released to our practice or from our practice, please use the following form to authorize the release.

All forms are PDF documents and if you have problem viewing them, you can download a Free Adobe Reader at www.adobe.com. We look forward to helping you with all your allergy and asthma needs.