New Patient Information

What to expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. We look forward to your first visit.

Please read through the Office Policies and Information page on our website. There you’ll find all the practical information you need, such as a map and directions to our office(s), practice hours, payment policies and more. You can even save some time at your first visit by printing out and completing the new patient forms in advance of your appointment. (under patient resources/forms)

Just a few reminders regarding your visit.

*Co-pays and Co-insurances are expected to be paid at the time of service. Our office accepts cash, check, Mastercard, Visa, American Express, Discover and Care Credit. If your insurance card does not specify a copay/co-insurance or we cannot confirm the amount, our office will collect 20% of the allowable charge at the time of your visit. If you do not have payment, your appointment may be rescheduled.

* Self pay patients must pay a $100.00 deposit when scheduling appointment, this will go toward the cost of your visit.

*You will be asked to present your insurance card at every visit to ensure correct billing to your insurance company.

* All minors must be accompanied by a parent or legal guardian at each visit. If another person will be accompanying your child, a written consent signed by a legal parent/guardian must be presented at the visit. If you have legal custody of the child, other than their parent, please bring a copy of your custody paperwork from the court for our records.

* It is the patient’s responsibility to ensure that any required insurance referrals are received in our office by the date of the appointment. Your appointment may have to be rescheduled if the proper referral is not received.

*In order to provide the most accurate diagnosis, our providers may perform additional testing and/or procedures during your visit. This may include, but is not limited to, audiogram, tympanogram, flexible laryngoscopy, sinus debridement, nasal endoscopy, nasal cautery, cerumen (wax) cleaning, biopsies and minor surgical procedures. These procedures and testing are billed in addition to your office visit charges. Most insurance companies apply these costs to your co-insurance or deductibles depending on your individual insurance policy. After submitting our claim to your insurance company, these additional costs may become patient responsibility and will be billed to you by our office. If you do not wish to have testing or procedures performed, please discuss this with your provider at your visit.

Patient Forms

Please print and fill out these forms so we can expedite your first visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed.   Click HERE to download

Patient Information

English
Spanish

Health History

English
Spanish

Medical release

English
Spanish

HIPPA Patient consent

English
Spanish

HIPPA – please review form below by following the link.

HIPPA English
HIPPA Spanish

Hours:

Monday – Friday  8:00 am – 4:30 pm

(Closed 12-1 for lunch)

Saturday and Sunday Closed

Call For Appointment:

540-722-7282