First, for ALL patients, read this instructional sheet: CLICK HERE


****Then please click on BOTH forms for each patient (either adult or child)****


ADULT NEW PATIENTS (over age 18)


Prior to the visit, fill out BOTH forms:

1. Registration Form (ADULT)

2. Clinical Form (ADULT)



CHILD NEW PATIENTS (under age 18)


Prior to the visit, fill out BOTH forms:

1. Registration Form (CHILD)
2. Clinical Form (CHILD)



  • If you are unable to fill out these forms in advance, arrive at least 15 minutes beforeyour appointment time to complete them in the office. ​ Otherwise this could possibly take away from time with the doctor.


  •  If prior allergy testing, breathing tests, blood tests,  or X-rays/CT scans were performed that pertain to your visit, please bring all pertinent test reports to your visit


  • You may need to request test records from your doctor in advance; please only request pertinent results (not the entire medical record); you may use this form:  

Release of Records TO our practice. 


Medications to Stop Before Your Appointment

(This is included in the New Patient Registration.)


Injection Hours (Printable)



Release of Records FROM our practice (to you or another office) - not needed at the first visit

(Please allow up to 2 weeks to process your request. There may be a fee for multiple pages)


Billing and Financial Policy

(This is included in the New Patient Registration.)


Notice of Privacy Practice


PATIENT FORMS

Renee Lantner, MD

​5600 S. Wolf Road Suite 135

​Western Springs, IL 60558


    PHONE: 708-246-4515   FAX: 708-246-4502

Western Springs Asthma & Allergy