Forms
New Patient Forms
If you are a new patient to us, or if you are an established patient that has not been seen in over 3 years, we kindly ask that you fill out your new patient registration paperwork online before the day of your appointment to avoid delays. We use a service called Phreesia that will email and text you a link to your registration forms.
If you need to print the documents to fill out at home, you may download and print these forms and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process and avoid delays.
Please also bring with you:
- Insurance card and form of photo identification
- Referral from primary care physician (if required by insurance). See FAQ on referrals.
- Imaging (CT/MRI/X-ray) results on CD if you have them, and/or the report
- Recent audiology results if you have them
If you want to contact your insurance company for visit or procedure cost estimation, please see information to help you on this page.
Audiology Forms
If your visit is relating to tinnitus/hearing loss/dizziness, please also fill out the corresponding questionnaire:
Sleep Forms
If your visit is sleep related, we ask that you also complete the sleep questionnaire:
Other Documents
The documents on this page may require Adobe Acrobat Reader. To download Acrobat, click on the link below.
Adobe Reader
We're Ready to Assist You
Relief from ear, nose, and throat disorders is closer than you may think!
If you’d like to schedule an appointment, contact our office by phone or reserve an appointment online. Our practice locations are in the Trinity and Wesley Chapel areas of Pasco County, making quality care easily accessible. To meet the evolving needs of our community, we’re also pleased to offer convenient ENT telehealth appointments that allow patients to consult with our professionals from the comfort and safety of home.
