ENTA FORM
ENTA FORM

ENT Forms

Please take the time to fill out these forms in advance. When done, it will make it easier for you to be registered and seen when you come to the office. MOST IMPORTANTLY: PLEASE COME IN TWENTY MINUTES BEFORE YOUR APPOINTMENT TO GIVE OUR STAFF THE TIME TO PLACE YOUR INFORMATION IN OUR ELECTRONIC MEDICAL RECORD.

About Your Visit

What you should bring to your appointment at ENT and Allergy Associates, LLP:

  • Health Insurance Card/Information
  • A friend or family member to take notes/help with questions
  • A list of all medications you are taking
  • A list of your questions /concerns
  • A copy of your XRAYS / CT scans (not the reports - get the actual films or CD)
  • Copies of records from doctors related to your ear, nose and throat problems
  • Completed FORMS (see below)
  • A photo ID

In order to expedite the patient registration process, please download the registration form below, print all four pages, fill it out and bring it/them with you on your first visit to our office. Thank you!

ENT and Allergy EMR History Form, Microsoft Word version

ENT and Allergy EMR History Form, PDF version

FORMULARIOS en Español , Microsoft Word

FORMULARIOS en Español , PDF version

Patient Notification Form, Microsoft Word

Patient Notification Form, PDF Version

Preauthorization To treat Minors Without Parent or Legal Guardian, PDF Version

This file is in Adobe Acrobat PDF format. If you don’t have the viewer already installed on your computer, you can get a free copy of the latest Acrobat Reader here.

If you are unable to download the Adobe Acrobat Reader, please click on the appropriate link below to access a graphic version of the registration form, print it, fill it out and bring it/them with you on your first visit to our office. There are FOUR (4) pages that need to be printed, so please make sure that you print ALL FOUR pages...thank you!

ENT and Allergy EMR History Form
ENT and Allergy EMR History Form - Spanish

We have also added an Patient Authorization for Release of Information form:

ENT and Allergy Patient Authorization Release Form, Microsoft Word version

ENT and Allergy Patient Authorization Release Form, PDF version

Other Forms:

ENG Testing, English Instructions

Allergy Testing, English Instructions

ENG Testing, Spanish Instructions

Allergy Testing, Spanish Instructions

Privacy Notice, English Copy

Nondiscrimination Notice, English 

Privacy Notice, Spanish Copy

FINANCIAL AGREEMENT

2016 ENT Calendar Final