Allergy Portal

Patient Information

I am requesting to reorder and continue allergy injections/sublingual drops. I understand the allergy extract that I am ordering is prepared specifically for me and it cannot be used by any other person. If I choose not to use this vial/bottle of extract, I realize that I am still financially responsible for it. I, therefore, authorize Breathe Clear Institute to bill my insurance for this extract. I also understand that I am required to pay my out-of-pocket costs such as copays, co- insurance and/or deductibles at the time of reordering. For Sublingual Immunotherapy, I understand I am required to pay at the time of reorder.

Please note: If it has been more than 6 months since your last appointment with us, you will also need to see one of our providers either in person or by telehealth.