New Patient Forms

Prior to Your Arrival

Prior to your arrival for your appointment and for your convenience, please download and complete the following form:

Patient Information and Medical History Form

 

Per HIPAA requirements, we are providing the Patient Information Release Form for your reference below. It is for informational purposes only. It does not need to be brought to your appointment nor does it need to be signed.

Patient Information Release Form

These forms require Acrobat Reader. If you do not have Acrobat Reader, please visit Adobe.com for a free download.

 

Once downloaded, please print and complete the
Patient Information and Medical History Form
using a blue or black pen and then bring it with you
for your scheduled appointment.

Thank you!
The Staff of BergerHenry ENT

 

We accept all local and major health insurance plans.

Insurance copayment is expected at time of service. We accept Visa®, MasterCard®, Check, Cash, and now CareCredit®. For more information on CareCredit® please contact our office.

If you do not have health insurance payment is expected at time of service.

We accept Visa, MasterCard, Check, Cash, and now CareCredit.

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