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:
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
