Patient Registration

Please Note: We have a new Patient Portal

If you have not already done so, please This email address is being protected from spambots. You need JavaScript enabled to view it. to request an invitation to register with the new portal before using the login button below.

RegistrationThe easiest and most convenient way to fill out your new patient paperwork is to register with our patient portal. This will allow you to fill out both our patient information form and patient history form online. If you prefer a more conventional method to registration, you can print off our patient information form and bring it with your when you come for your first appointment.

Our online patient portal will allow you to access all online services offered including:

  • Updating demographics
  • Updating email address
  • Updating username and password
  • Communicating with our office via secure email
  • Gaining access to previous visits and requesting test results
  • Paying your bill online

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Patient Forms

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Items Needed For Your First Appointment

  • Completed Patient Information Form - if not completed via the Patient Portal
  • Health Insurance Card(s)
  • Drivers License
  • Health Insurance Co-Payment
    You will be asked to pay your co-pay upon check-in for your appointment. We accept cash, check, VISA and MasterCard. If you do not have health insurance, payment is expected at the time of service unless other financial arrangements have been made prior to your visit. Our billing office will assist you with any questions at (615) 889-8802.
  • Referral Form
    If your plan requires a referral from your primary care physician, it is your responsibility to obtain it prior to your appointment. If you do not have your referral, you will be asked to reschedule your appointment.
  • List of Medications and Allergies
    Please bring a list of your current medications with dosages (including over-the-counter and herbal substances), a list of any medications that have been used to treat your current problem in the past (even if you are no longer taking them or if they were ineffective) and a list of any allergies you may have.
  • List of Past Medical Conditions and Surgeries
    We will place all of this information into our Electronic Medical Record and you will not be required to bring it to each visit after your initial encounter. We will ask you to update it with new information at each subsequent visit, as it is essential for our providers to know in order to provide you with the best care possible.
  • Pediatric Visits
    Minors must be accompanied by a parent or guardian for their initial visit. If accompanied by another adult during a subsequent visit, we must have a completed Child Treatment Consent form.

Insurance

We participate in most insurance plans. Your health plan is a contract between you and your insurance company.  Not all services provided by our office are covered by every plan. If you have any questions regarding your specific plan and coverage, we recommend contacting member services at the number located on the back of your card with any questions or for clarification. You are responsible for all co-pays, deductibles, co-insurances, cost-share and non-covered services. If your insurance carrier determines that you are not eligible for benefits, you are financially responsible for all charges. Please click here see what insurance plans we currently are accepting.

Cancellations

Please cancel 24 hours in advance if you cannot keep your scheduled appointment so that your appointment time will be available for other patients. If you do not provide this notice, we may require a deposit of $25 for any future appointments you wish to schedule.
If you have any questions or concerns prior to your visit, please don’t hesitate to contact us. We look forward to seeing you!

Allergy & ENT Associates of Middle Tennessee, PC
3901 Central Pike, Suite 351  •  Hermitage, Tennessee 37076
103 Physicians Way, Suite 140  •  Lebanon, Tennessee 37090
Phone: 615.889.8802  •  1-888-Y-SNEEZE  •  Fax: 615.889.0583