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ENT Surgical Associates Michigan

(248)-541-0100

First Visit

Welcome to E.N.T. Surgical Associates

first-visit

In order to make your initial visit to our office as efficient as possible, please bring the following information with you:

  • Completed New Patient Form, Patient History Form, Pharmacy Form, Privacy Notice Acknowledgement (see links below to Download and Print forms).
  • List of your current medications, doses and complete pharmacy information.
  • Previous CT scans, X-rays, or test results related to your current medical condition.
  • List of medication allergies and environmental allergies (if any).
  • Referring Physician (Name, Address, and Phone Number), or person who is referred you to our office.
  • Family Physician/Primary Care Physician (Name, Address, and Phone Number).
  • Current Insurance Card and Picture Identification must be presented at time of visit.
  • If applicable, a referral form or written notification from your primary care doctor must be with you at the time of visit.
  • If the reason for your visit is due to an auto-accident or work-related injury, please bring your insurance company name, claim number, adjuster's name, phone number, and an address where claims should be sent.

*Due to sensitivities experienced by many of our allergy patients, we ask that you Please do not wear any perfume, cologne, or aftershave, as we are a FRAGRANCE-FREE office.

Payment is expected at the time of visit on all copays, deductibles, and self-paying patients.  For your convenience, we accept cash, check, and Visa/MasterCard.

We look forward to seeing you. Please contact our office if you have any questions.

*Please Note: There will be a $10 fee charged to your account for any appointment not cancelled within 24 hours.

Thank you,

E.N.T. Surgical Associates