Call To Schedule an Appointment

Downtown Columbia Main Office
(803) 929-0290

Parkridge / Irmo Office
(803) 407-0701

Northeast Columbia Office
(803) 788-8603

Physician’s Consult Request

For urgent problems, same day appointments are always available. For an urgent allergy or asthma problem, please call our office to schedule the appointment.

For non-urgent problems, our staff will contact you by phone or email to confirm appointment details. Thank you for trusting us for your allergy and asthma care needs.

Patient's Name

Parent's Name (for children)

Patient's Date of Birth

Physician Requesting Consultation

Physician's UPIN

Physician's E-mail

Physician's Office Contact Person and Phone Number

Reason for Consult Request

Preferred Doctor

Preferred Office

Patient's E-mail

Patient's Phone

Patient's Home Address

Insurance Type

Notes

 

Carolina Allergy and Asthma Consultants