Patient Forms

 

 patient-formsAt Ear, Nose & Throat Associates of New York, we strive to make your registration and check-in process as quick and as seamless as possible. In order to cut down on your wait time, we ask that you download and complete the applicable registration form from the list below. Please remember to bring the completed form and all supporting documentation with you on the date of your visit.

PRE-PRINTED REGISTRATION FORMS ARE ONLY BEING ACCEPTED AT THE FOLLOWING LOCATIONS:

Queens

Bronx

Long Island

SUPPORTING DOCUMENTATION REQUIRED:

  • Health Insurance Card
  • Referral, if required
  • Photo ID
  • Completed Patient Intake Form (below)

PATIENT REGISTRATION FORMS:

New Patient Intake Form:
 English New Patient Registration Form
 Spanish New Patient Registration Form

Thank you and we look forward to continuously providing you the exceptional service you have come to know and deserve.