Patient Information
Please note that you will receive a text and email three days prior to your appointment from Phreesia, prompting you to complete your new patient registration packet. If for any reason you can't complete forms electronically, please complete and print the forms provided below to bring to your appointment.
If you cannot do either, please arrive 15 minutes prior to your appointment to complete the paperwork.
Your options are:
- Complete new patient registration forms via Phreesia
- Print and complete the forms listed below
- Using Adobe Acrobat Reader, download, fill in and print the forms below
- Request the forms to be mailed to your home
Make sure you bring your insurance card and co-pay to your visit. Bring a list of all the medications you have taken in the last year, and any relevant lab work done in the last two years. Please be prepared to be here for at least one hour in order to allow a thorough evaluation.
You will initially be seen by our trained allergy nurse who will obtain vital signs, record your medication list and perform pulmonary function testing if you have any respiratory or cough issues.
You will then spend extensive time with Dr. Cymerman. Much of that time will be discussing why you are here, what evaluation and treatment you have had in the past, and most importantly, what events led up to your current condition. A physical exam relevant to your allergy symptoms will be performed; a loose-fitting shirt is helpful.
Allergy testing via skin prick testing may or may not be performed the first visit, depending on what medications you are taking, what your respiratory status is and other factors. Skin testing can NOT be done if you have NOT eaten in more than an hour, if you are ill, if you have a reduced respiratory status or if you have taken antihistamines in the previous 72 hours. If Dr. Cymerman assesses allergy testing to be appropriate, skin testing will be performed. Please keep in mind skin testing is not appropriate for every patient for a number of possible reasons.
Please do not stop any asthma medications that you are taking under any circumstances.
Patient Forms in English:
- Patient Registration Packet (English)
- Our Office Policy (English)
- Follow-Up Environmental Form (English)
- Allergy Injection Consent Form (English)
- Patch Testing Form (English)
- Skin Testing Form(English)
- Medical Record Release Form
Formularios del Paciente en Español:
- Patient Registration Packet (Spanish)
- Our Office Policy (Spanish)
- Follow-Up Environmental Form (Spanish)
- Allergy Injection Consent Form (Spanish)
- Patch Testing Form (Spanish)
- Skin Testing Form (Spanish)
Useful Links:
Telehealth Services
At Long Island Allergy and Asthma, your health and safety are our top priorities. We continue to monitor the COVID-19 outbreak and are taking all the necessary precautions to ensure everyone's safety.
In response to this, we have added a Telehealth service to our practice so we can continue to serve your medical needs during this time.
Our platform is HIPAA secure and your physician can conduct your exam in a safe, virtual environment. Please call us at (631) 751-6262 to schedule your Telehealth visit.
To learn more about how to prepare and what to expect from your appointment visit:
www.stonybrookmedicine.edu/patientcare/telehealth/your_telehealth_visit
Good Faith Estimate
If you are uninsured, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our office.
Insurance
Long Island Allergy and Asthma currently works with over 30 major insurance companies. Our staff is always working on accommodating our patients and their insurance providers. We accept cash, checks, VISA and MasterCard as payment for co-pays and insurance deductibles. Please call our office at (631) 751-6262 for further information or to find out if your carrier is on our continuously expanding list of providers.
- 1199SEIU National Benefit Fund (through Aetna Health Plans)
- Aetna Health Inc.
- Affinity Molina/Medicaid, Child Health Plus
- Affinity/Molina Medicaid
- AgeWell New York Plans
- Beech Street, a MultiPlan Network
- MagnaCare PPO /Direct Plus (Brighten Health Plan)
- Magnacare Northwell Direct (wrap-around network)
- CenterLight Healthcare
- Cigna HealthCare of New York HMO, PPO, Open Access
- Emblem Health-Somos
- EmblemHealth Plan, Inc., (GHI)
- Healthcare Partners (Specialists only)
- Emblemhealth Plan (HIP)
- Empire HealthChoice HMO, Inc.-Prefixes - R4R, ZTO, PYO, S8Q, KCH, YXF, AZL, J2H, C4D, YKH, HPP, D9U, PTQ, EQV, VRH, VYW, L4P
- Empire HealthChoice HMO, Inc.-Federal Employee Program (Prefix R)
- Empire HealthChoice HMO, Inc.-EmpireBlue _ Northwell Direct Tier 2
- Empire HealthChoice HMO, Inc.-Blue Cross Blue Shield Global Core
- Empire Blue Cross (confirm plan with Empireblue.com)
- Empire Medicare Advantage HMO Plans (not Select Plans)
- Empire BlueCross BlueShield HealthPlus Medicaid/ Child Health Plus (Prefix JLJ)
- Empire Plan, the New York State Health Insurance Program (NYSHIP)
- Excellus Health Plan, Inc.
- Fidelis Medicaid, Child Health Plus, HealthierLife
- Healthfirst Medicaid, Child Health Plus, Essential, Personal Wellness
- Humana ChoiceCare Plans as a Wrap-Around GHI Network Access
- Humana TriCare
- MultiPlan PPO/PHCS/Limited Plan
- Oxford Freedom
- Oxford Liberty
- Partners Health Plan
- UnitedHealthcare Community Plan-Medicaid, Child Health Plus, Wellness4Me
- UnitedHealthcare of New York, Inc.-All Savers
- UnitedHealthcare of New York, Inc.-Bind Health Insurance
- UnitedHealthcare of New York, Inc.-Choice Plans
- UnitedHealthcare of New York, Inc.-Compass Plans
- UnitedHealthcare of New York, Inc.-Doctors Plan
- UnitedHealthcare of New York, Inc.-The Empire Plan/NYSHIP
- UnitedHealthcare of New York, Inc.-Heritage Plans
- UnitedHealthcare of New York, Inc.-Navigate Plans
- UnitedHealthcare of New York, Inc.-NexusACO Tier 1
- UnitedHealthcare of New York, Inc.-Options Plans
- UnitedHealthcare of New York, Inc.-Passport Connect Choice Plans
- UnitedHealthcare of New York, Inc.-Select Plans
- UnitedHealthcare of New York, Inc.-Signature Value Plans
- UnitedHealthcare of New York, Inc.-W500 Emergent Wrap
- UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)
- United Healthcare Assisted Living Plan (PPO I-SNP)
- VA Community Care Network
- US Family Health Plan-Limited participation
**Disclaimer**
Insurance plan participation may change over time. While every effort is made to ensure the accuracy of this information, we recommend that you confirm participation status with your insurance carrier or practice. Please note that insurance plan participation requirements may be waived when a patient receives medical treatment in an emergency.