Click here for New Patient Registration Forms (ALL new patients)


For immunodeficiency patients, click here for additional form.


Fax number to send records to our office: 772-783-1012


  • If you are unable to print and fill out these forms in advance, please come 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 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

Chhavi Gandhi, MD

G. Wendell Richmond, MD​

Western Springs Asthma & Allergy

5600 S. Wolf Road Suite 135,  Western Springs, IL 60558   P: 708-246-4515   F: see CONTACT US