Patient Forms

New Patient Forms

Patient forms are available online for your convenience. Please print and fill out all New Patient forms and bring them to your consult visit. New patient appointments will last approximately an hour to an hour and half.  

New Patient Registration

Financial and Insurance Policy

Other Forms

Authorization to come with Adult

Medical Record Release Form

Medical Record Forms and Information

  • Medical records will be sent to other physicians at no cost to patients after obtaining a valid medical record release form signed by patient.

  • Patients requesting copies of medical records for personal use will be charged a standard fees. Payment is required prior to records being released.

  • Please allow up to 2 weeks for copies of records. 

Mt. Lebanon Allergy & Associates, Inc.

St. Clair Hospital, JMA Building, Uniontown

phone: 412-405-8475  fax: 412-278-1399