Patient Registration Forms

What you should bring to your appointment at ENT & 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
• 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
• Privacy Notice, Spanish Copy
• FINANCIAL AGREEMENT
• Financial Hardship Application