Patient Forms

Thank you for choosing Amherst Ear, Nose & Throat. We understand your time is valuable. In order for you to have the best possible experience here at our office, please be prepared with the following information when you come in for your appointment. Please arrive 10 minutes prior to your scheduled appointment to give us time to verify and input all your information.

Important items to bring

♦ COMPLETED FORMS  (Click to Print)

♦ Health Insurance Card(s)

♦ Photo ID  (Driver’s license or other State or Federal picture ID)

♦ Insurance referral (if needed)

♦ Co-pay, co-insurance and deductible (will be collected at time of service)

♦ List of current medications you are taking and dosing details

♦ Recent test results: diagnostic reports, CT, X-ray or MRI films (we require actual films, NOT a CD). FAILURE TO BRING THESE MAY RESULT IN YOUR APPOINTMENT BEING RESCHEDULED.

♦ Copies of records from referring doctor