Adult Patient Registration Form

As a new patient we require numerous forms to be read and signed. This can be done in our office or at the convenience of your home.

Please read the following protocols then at the bottom of the page click on one of the two links depending on what health plan you have.

Front desk staff (receptionist) make appointments per availability and take phone messages for the Triage nurse. They do not have privileges to overbook or add-on patient appointments.

Triage Nurses return patient phone calls during regular office hours and are highly trained to make recommendations regarding your ear nose and throat problems. Our nurses rotate through this position, therefore, you might speak to a different nurse each time you call. The triage nurse will offer an appointment, call in a prescription and/or offer nursing advice per written protocol from our group of physicians.

Emergency After Hours Calls - A Capitol Ear, Nose & Throat nurse is on call for emergency advice during specific times on weekends and holidays. Fridays 5pm-9pm / Saturday and Sunday 8am-7pm. If your emergency occurs during other times the on-call physician will return your call. If you do not receive a call back within 15 minutes please call the office number again, tell the operator you are calling for a 2nd time and she/he will page the physician again or contact him by phone. When the office is closed our physicians rotate call coverage, therefore, your regular physician may not be the physician handling your emergency.

After-hours medication requests are extremely limited due to lack of medical record access.
NARCOTICS WILL NOT BE CALLED IN AFTER HOURS BY A PHYSICIAN OR NURSE.

Appointment Protocol

Protocols are office wide and are determined by our physicians as a group.

• Advice may only be given to an established patient or family member as indicated by HIPAA release.
• Patients are to see their regular physician if at all possible.
• Same Day Appointment
• Nose Bleed (active)
• Foreign Body of ear or airway
• Fever over 103 degrees (pt may be asked to see their PCP or pediatrician)
• Peritonsillar Abscess
• Sudden Hearing Loss
• Wound /Incision Abscess or Hematoma
• Airway Obstruction

Medication Refill Protocol

All medication refill requests MUST come via Fax from your pharmacy.

*** ANTIBIOTICS: Only if patient seen and treated within last 30 days. Follow up appt required. ***

Refills on medications used for "chronic" conditions require an annual visit with the physician.

NARCOTICS WILL NOT BE CALLED IN AFTER HOURS BY A PHYSICIAN OR NURSE.

Financial & Insurance

• You are responsible for payment of your account.
• Patients will be expected to pay at the time service is rendered.
• In the case of surgical fees, prior arrangements should be made with our billing department.

We participate in the following health care plans:

If you see your insurance company listed: click here
If you do not see your insurance company listed click here