New Patient Forms:
You will be sent our patient intake forms to your e-mail or mobile device on file before your appointment through our online check-in portal.
If you opt-out of this feature, please complete the forms below for your provider and bring them with you to your appointment:
Dr. Apaliski’s New Patients: Please download and complete Dr. Apaliski New Patient Paperwork
Dr. Earl’s New Patients: Please download and complete Dr. Earl New Patient Paperwork
Dr. Singhania’s New Patients: Please download and complete Dr. Singhania New Patient Paperwork
We do not accept Medicare – Medicare Eligible Patients must sign this Medicare Notice also.
Medical Records Request:
Download a printable PDF of our Medical Records Request
Review our Privacy Policies
If a minor is coming to an appointment or injection without a parent or legal guardian, please fill out a Authorization to Treat a Minor form before the appointment. Failure to present this form at the time of the appointment may cause us to cancel and reschedule the appointment to a different time. The adult bringing the minor must be 18 years or older and be able to show identification if asked.
AACM will receive school forms via fax- patient portal- and in person! Please make sure you submit a School Form Authorization with the school forms. You will also need to make sure all the parent information, medications requested and signatures are on the forms when submitted. *If this information is not on the form, it will delay the completion process.*
School forms require a $15.00 fee per school year, per family. This will cover all children, plus any changes we will need to make throughout the school year.
If you have any questions, please call 817-460-7447 to speak to a friendly member of our staff!
Preparing for Your First Visit
Please fill out the above patient and insurance information forms and bring them to your appointment, as this will save time. You can also fill out the forms when you get here–please arrive 15 minutes prior to your new patient appointment.
Please bring your asthma/allergy medications and any relevant medical records to your first appointment if possible.
Your doctor will evaluate you and make recommendations. A typical new patient visit can vary from 30 minutes to 1 hour. Thank you.