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ENT Surgical Associates Michigan


First Visit

Welcome to E.N.T. Surgical Associates


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