Contact Us Today: (817) 460-7447
Patient Portal

Patient Forms

/Patient Forms
Patient Forms 2020-08-06T15:37:00+00:00

New Patient Forms:

You can save time by filling out our new patient forms before your appointment! Just print them, fill them out, 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

Download a printable PDF of our Medical Release Form.

We do not accept Medicare – Medicare Eligible Patients must sign this Medicare Notice also.

Review our Privacy Policies

Current Patients:

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.

School Forms:

Hello Parents!

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.

Patient Portal

Existing Patients — Access our Patient Portal

How-To-Use Videos:

How to use a nebulizer machine with face mask or mouthpiece:  https://www.youtube.com/watch?v=fz2WCNbBDBM&t=9s

How to use a nebulizer machine: https://www.youtube.com/watch?v=pEKFKZiLNaA

How to use an inhaler: https://www.youtube.com/watch?v=9ipqxF-4p5g

How to use an inhaler with spacer and facemask:  https://www.youtube.com/watch?v=Y52QUekiG5U

How to use an inhaler with spacer: https://www.youtube.com/watch?v=0bU6fCN44FA

How to use Spiriva Respimat: https://www.spiriva.com/asthma/how-to-use

How to use an Ellipta Inhaler: https://www.youtube.com/watch?v=E6X0zW4HQLk

How to use an Advair Diskus: https://www.youtube.com/watch?v=IW9thi9HtaM

How to use a Asmanex Twisthaler: https://www.youtube.com/watch?v=-QiVfPN82Ew&t=28s

How to use QVAR Redihaler: https://www.youtube.com/watch?v=NsA_8kW8trg

How to use Respiclick Inhalers (ex. Proair or AirDuo): https://www.youtube.com/watch?v=n1CNIxoFG5E

How to use Xhance nasal spray: https://www.youtube.com/watch?v=E3qolHDKRSU

How to use an Auvi-Q: https://www.auvi-q.com/about-auvi-q

How to use an Epipen: https://www.youtube.com/watch?v=dEQNwZojEw4