Prior to arriving for your ENT doctor’s appointment
Patient Information and Medical History Form
Prior to your arrival for your ENT doctor’s appointment and for your convenience, we ask that you download, complete (with blue or black pen), and bring the Patient Information and Medical History Form with you. Please click the PDF icon or the highlighted blue text to begin your download. Please note that these forms require Acrobat Reader. If you do not have Acrobat Reader, please visit Adobe.com for a free download.
Patient Information Release Form (with Financial Policy appended)
The Patient Information Release Form can be downloaded but your signature is not required. You will be asked to sign it electronically at your appointment in the BergerHenry ENT offices. You will also note that there is a Financial Policy page appended to the end of this form. Per HIPAA rules, this form must be signed in the presence of BergerHenry ENT staff. Please wait to sign and date it until you are at your appointment. Please click the PDF icon or the highlighted blue text to begin your download.
Health Insurance and Co-Pays
We accept all local and major health insurance plans. Insurance copayment is expected at time of service. We accept Visa®, MasterCard®, Check, Cash, and CareCredit®. For more information on CareCredit® please contact our office. Please note that if you do not have health insurance, payment is expected at time of service.