Resources | Allergy & ENT Associates

Patient Forms

New Patient Information: Medical History FormDownload New Patient Information: Consent and Registration FormDownload Child Treatment ConsentDownload Notice of Privacy PracticesDownload No Suprises ActDownload Accepted Insurance PlansDownload Patient Bill of RightsDownload Financial PolicyDownload Allergy Drop Reorder FormDownload Medical Release Form to usDownload Medical Release Form from us: https://medicopy.net/roi

HIPAA Statement

NOTICE OF PRIVACY PRACTICES Privacy Officer: Kelly Morgan 615-889-8802 Effective Date: 09/23/2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information.…

Bill Pay

*Patient Name and Account No.:

Medical Records Request

Steps For Requesting Your Medical Records 1. Submit an authorization form online, or download a .pdf version: Auth Form (English) or Auth Form (Español) The .pdf version of the authorization form can be submitted by the following methods: Upload: Click here to upload a pdf version of the requestEmail: A .pdf of the completed…