Patient Forms
ANNOUNCEMENT
With great sadness, we announce that Southcoast Allergy, PA will be permanently closing on Feb 28, 2019, due to Dr. Kovacs' failing health.
Our last day to see patients will be Feb 27th.
We appreciate the many years of loyalty and patronage from our patients. For his Allergy/Immunology patients, Dr. Kovacs recommends continuing care with Dr. Michael Neuland or Dr. Carla Hinds. Please stop by the office at your earliest convenience to sign a records release and let us know who to send your records to.
 » Click here to download a Medical Records Release Form
Please Note: You must have Acrobat Reader installed on your computer to view or print documents.
Click to download a free copy from the Adobe website.
Fax: (850) 897-1259
Email: susanrasinssca@outlook.com
Mailing Address: P.O. Box 538 Niceville, FL 32588
New Patient Forms:
Please print and fill out all of the New Patient Forms before your first scheduled office visit. Thank you!
» New Patient Forms - 2018 - 12 pages, including the following:
- New Patient Demographics
- Patient Questionnaire
- Notice of Privacy Practice
- Financial & Insurance Policies)
- Office Policies
- Medical Information Release Authorization
General Patient Forms:
» Authorization for Release of Medical Information (1 page)
» Authorization to Designate Another Party to Accompany / Consent to Treat Minors
Please Note: You must have Acrobat Reader installed on your computer to view or print documents.
Click to download a free copy from the Adobe website.
|
News & Specials
Services
Our Providers
Office Information
Patient Information 
Patient Forms 
Resources
Pollen Count
Pay Your Bill Online
Patient Portal