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New Patient Forms

Directions

Welcome to our practice.
We are very pleased you have selected us for your medical care.

Please fill out the attached New Patient FormsCompleted forms should be returned to our office prior to your appointment. Forms can be dropped off, mailed to the Mandeville office or faxed to 205-623-1080. This will allow us time to review your medical history.

If you are unable to submit the forms completed prior to your appointment, please arrive at least 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 scheduling with us (sinusitis, hearing loss, repeated ear infections, tonsillitis, etc.), please request copies of pertinent medical records (including physician’s notes, radiology reports, lab results, sleep studies, etc.) in advance of your appointment.  For your convenience, records can be faxed to 205-623-1080.

Please note, we file your insurance as a courtesy. It is the patient’s responsibility to know benefits and to contact the carrier with any questions regarding your coverage.  Please remember to bring your insurance card and a picture ID to every appointment. Insurance co-pays and deductibles are due 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.

If you have any questions, do not hesitate to call so that we may assist you.

Sincerely,
Patricia Dugas, Practice Manager

Ear, Nose, Throat

Allergy

Hearing & Balance

Sleep

Facial Plastics

Surgery Center