New Patient Forms


Welcome to our practice.

We are very pleased you have selected us for your medical care. Please complete the New Patient Forms prior to your appointment. If you have any questions, do not hesitate to call so that we may assist you.

Completed forms should be returned to our office prior to your appointment. Forms can be dropped off, mailed to our Mandeville location or faxed to 205-623-1080. This will allow the doctors time to review your medical history and will prevent delays in seeing the doctor. If you are unable to submit the completed forms prior to your appointment, please arrive 30 minutes early. We may need to reschedule your visit if your paperwork is not completed prior to your appointment time.

If you have been treated by a physician or hospital for the reason you are visiting us (Example: sinusitis, hearing loss, repeated ear infection, tonsillitis, etc.), you should request copies of pertinent medical records (including physician’s notes, radiology & lab results, sleep studies/compliance data, etc.) in advance of your appointment.

Please note, we file your insurance as a courtesy. It is your responsibility to know the benefits and to contact the carrier with questions regarding your coverage. Please remember to bring your insurance card and a picture ID. Insurance co-pays and deductibles are collected on the day of service. We accept cash, check and all the major credit cards.

In consideration to other patients and staff, we request at least 24-hour notice if you are unable to keep your appointment. Failure to give notice will result in a $25 cancellation fee. Thank you for choosing our office. We are looking forward to meeting you and providing you with quality care.

Patricia Dugas, Practice Manager

New Patient Forms Here


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