Welcome to our practice, the Southern New England Ear, Nose, and Throat and Facial Plastic Surgery Group, LLP. We look forward to meeting you for your appointment.
We have 3 forms which need to be completed for new patients. To expedite your first visit, please download/print the 3 forms listed below. Fill in the required information in blue or black ink, and bring all 3 forms with you to your visit.
Forms: (please click form to open in your browser - or right click and select print . Alternatively, select 'save' to download and save to hard drive folder, and print later.)
Click on individual form below :
1. Patient Identification
2. Patient History
3. HIPAA (Privacy Practices)
ALL 3 FORMS
Fill in the required information legibly in blue or black ink, and bring all 3 forms with you to your visit.
To make your visit as efficient as possible, please remember to bring the following with you:
3. a listing of your current medications and allergies
4. your copay (check, cash, or credit card accepted).
5. a photo ID (driver license, CT. state ID, passport....)
Thank you for your cooperation.
COPAYS AND DEDUCTIBLES ARE EXPECTED AT TIME OF VISIT.
WE ACCEPT ALL CREDIT CARDS.
COPAGOS Y DEDUCIBLES SE ESPERA EN EL MOMENTO DE LA VISITA.
ACEPTAMOS TODAS LAS TARJETAS DE CREDITO.
SNEENT DE GESTION