Charlottesville Allergy & Respiratory Enterprises
434-295-ASAP (2727) 1524 Insurance Lane, Suite B, Charlottesville, Virginia 22911


Patient Forms & Information

Allergies & Asthma - Understanding the Puzzle

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  • Please review Patient Forms & Information above. Please print and complete these forms, and bring them with you at the time of your appointment. This will reduce your waiting time in the office. You can also choose to complete them in the office prior to your appointment.
  • We look forward to making your experience comfortable and to keep you on schedule with your visit. If you are a new patient, please plan on arriving 15-20 minutes prior to your appointment time to complete the registration procedure. One of the parents or a legal guardian must accompany a minor for all visits.
  • Please bring your current insurance card along with one form of identification.
  • If your insurance company requires a co-payment, please be prepared to pay this at the time of the visit. We accept payments by Cash, Check or Credit Card (Visa, Mastercard, Discover or American Express).
  • Please do not forget to bring a list of your current medications. Please include any prescription or over-the-counter medications in the list.
  • If you must reschedule or cancel this appointment, please call us at least 24 hours in advance.
  • Please let us know how we may make your visit more comfortable. We certainly appreciate the value of your time and provide complimentary, secure Wi-Fi access onsite, along with a variety of readily accessible educational resources.


We accept all major insurance plans, including Anthem Blue Cross Blue Shield, Aetna, Cigna, Southern Health, United Healthcare, Medicaid, Medicare, Optima, Tricare and most other plans accepted by Martha Jefferson Hospital.  If your plan is not listed here, please call us at the number above and we will promptly confirm our participation status.


Suggested durations are listed below. You will need approval from your primary or other prescribing provider(s) if you take medication(s) for anxiety, depression, pain relief, as well as muscle relaxants and some other medications.

  • Actifed: 3 days (up to 7 days)
  • Allegra or Allegra-D: 7 days
  • Allergy medications - older, non-prescription (if they contain an antihistamine): 3 days
  • Astelin Nasal Spray: 5 days
  • Atarax or generic Hydroxyzine: 7-10 days
  • Axid: 2 days
  • Benadryl: 2 days
  • Brompheniramine (Bromfed, Rondec, Dimetapp): 3 days
  • Chlor-Trimeton: 3 days
  • Claritin or Claritin-D: 7 days
  • Clarinex: 7 days
  • Cough and Cold medications: non-prescription (if they contain an antihistamine): 3 days
  • Desipramine: 7 days
  • Doxepin: 10 days
  • Imipramine: 10 days
  • Maprotiline: 3 days
  • Muscle relaxants: non-prescription (if they contain antihistamines): 3 days
  • Pamelor, Surmontil, Tofranil, Triavil, Trimipramine and Vivactil: 3 days
  • Optivar: 2 days
  • Patanol or Pataday eye drops: 5-7 days
  • Periactin: 9 days
  • Pepcid: 2 days
  • Pepto-Bismol: 3 days
  • Phenergan: 3 days
  • Remeron: 3 days
  • Sinequan: 7 days
  • Sleeping aids: non-prescription (if they contain an antihistamine): 3 days
  • Tagamet or generic Cimetidine: 2 days
  • Tavist: 5 days
  • Tricyclic antidepressants: including Amitriptyline, Amoxapine, Anafranil, Asendin, Aventyl, Clomipramine, Elavil, Etrafon, Limbitrol, Norpramin, Nortriptyline: 10 days for most (only under the supervision of your primary or prescribing provider)
  • Zantac or generic Ranitidine: 2 days
  • Zonalon: 11 days
  • Zyrtec: 7 days

Many over-the-counter medications contain antihistamines. If you are uncertain whether a medication you are taking has an antihistamine effect, please call us at 434-295-ASAP (2727). Thank you.


If you fail to notify the office about your inability to keep a scheduled appointment at least 24 hours prior to such appointment, you will be charged a $75 no show fee (see Financial Policy Document for details).


Effective January 1, 2023, payments made via credit cards will have a surcharge of 3.5% to cover the increased merchant fees charged by credit card companies. Debit card payments will continue to be processed at no extra charge.


For forms provided by you, we will bill you $15 for the initial page and $5 for subsequent pages. For letters and documents created by us upon your request, you will be billed for actual time incurred but no less than $50. Please make sure your requests are clear and accurate when placed.


We understand that it may cost money to help keep your medical conditions under control, so we are committed to helping you locate cost savings where possible. Always check manufacturer sites and other online resources for cost savings. Make sure you compare different pharmacies. If you don't have prescription drug coverage, try looking at Partnership for Prescription Assistance to see if they can help.

Other References