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Patient Forms

Due to the large amount of information asked during your initial visit, we ask that any patient under the age of 18 be accompanied by their parent or legal guardian (please bring paperwork indicating guardianship). If a parent is unable to accompany the patient, we ask that a copy of the parent’s driver’s license and insurance card are included with the Registration Form. We also ask that you ensure whoever is bringing the patient to the appointment is listed on the Registration Form.

Patient Forms

New Patient Packet

Click to download

Consent for Medical Treatment of Minor Child

Click to download

Medical Records Release Form

Click to download

Immunotherapy Documents (click the links below to download)

Shot Calendar

Download the November shot calendar here

Download the December shot calendar here

Skin Testing & Procedure Information

If it has been determined that you will need skin testing, Dr. Brauer will have you return after having held your antihistamines for an appropriate amount of time, as these block our skin testing results. Our staff will review what specific medications will need to be stopped in order to conduct the testing. Most insurance plans at this time will not provide coverage for testing at the initial consultation visit. When you return for your testing visit, you should expect your visit to last at least 45 minutes.

After Hours Coverage

Our phone hours are 8:00 AM-4:00 PM Monday, Wednesday, and Friday, and 10:00 AM-5:00 PM Tuesdays. Please note that our office is closed Thursdays. As our calendar occasionally changes for holidays or vacations, our online shot calendar is updated regularly and published at least a month in advance. Please see our website at www.bluegrassfamilyallergy.com for any updates or questions about these hours. During regular clinic hours, someone will be available to answer your questions as promptly as possible by calling our office at 270-228-2811. We return all calls by the end of business each day.

Prescription Refills & Drug Samples

Please call your pharmacy if you need a prescription refilled, and have them fax a refill authorization to our fax number at 270-228-2812. Allow us 24 hours to process your refill. Note: Patients on regular maintenance medications are required to be seen in at least 6-12 month intervals. If it has been more than 12 months since your last appointment, we request that you be seen before further refills.

Financial policies

Co-pays and co-insurance payments are due at time of service. If your policy has a deductible that has not been met or co-insurance (percentage) that will need to be paid, you may pay in one lump sum or arrange monthly payments with our staff. Our office makes every attempt to estimate your owed amount on each claim and inform you of your financial responsibility in advance of your appointment.

Please be sure to verify Dr. Brauer’s participation with your insurance provider prior to your appointment. If Dr. Brauer does not participate with your insurance plan or the services rendered are not covered by your plan, payment will be expected at the time the service is provided. As a courtesy, we will file a claim with your insurance company. Also, if your insurance company denies payment to Bluegrass Family Allergy, PLLC for services performed, you accept full responsibility for the charges incurred. If your insurance requires a referral, you are responsible for obtaining this and bringing it to your appointment.

If you are unable to pay for services when they are rendered, please telephone our insurance and billing coordinator before your visit to establish a payment plan. If plans are not made prior to your visit, we may request that you reschedule.

You agree, in order for us to service your account, to allow us to notify you of information pertaining to your account or medical condition or for the purposes of collection, we may contact you by telephone at any number provided by you, including wireless numbers. We may also contact you by email or text message if you provide us this information.

Insurance

We accept most major insurance plans and most insurances do not require a referral.

NPI for Referrals

1639376296