Hidden
IMPORTANT NOTE: DO NOT, UNDER ANY CIRCUMSTANCES, EMAIL THE PATIENT USING THE EMAIL ADDRESS PROVIDED BELOW. DOING SO VIOLATES TEXAS ENT SPECIALISTS POLICIES AND IS A DIRECT HIPAA VIOLATION. USE THE INTRANET APPOINTMENT TEMPLATE FOR COMMUNICATION TO THE PATIENT.
Example: Minor child, parent, spouse
MM slash DD slash YYYY
Hidden
Section Break
-
Hidden
Section Break
Your truthful answer will help us be prepared to ensure we provide the safest care to everyone.
If you have had COVID symptoms and have not taken a recent COVID test which had negative results, we ask that you get a COVID test prior to your appointment and bring the results with you.
If you have a positive COVID test, you must schedule your appointment for at least 10 days after receiving the positive test. Seek treatment for COVID from your primary care physician.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
A Physician Assistant (or PA) is a highly trained medical professional who is there to provide care to select patients. They are not nurses or medical assistants; visits with the PA are no different than those with your regular physician. They can prescribe medication, order testing, etc. They will relay important information to your physician and you may still see your physician for future appointments if you so choose.
.
Please Note: We are unable to schedule surgeries from our website. To schedule surgery please contact the office directly.
Please Note: We are unable to schedule surgeries from our website. To schedule surgery please contact the office directly.
Please Note: We are unable to schedule surgeries from our website. To schedule surgery please contact the office directly.
Please Note: We are unable to schedule surgeries from our website. To schedule surgery please contact the office directly.
Hidden
Section Break
MM slash DD slash YYYY
MM slash DD slash YYYY
If we are unable to accommodate the above request, our scheduler will assign you to the next available appointment with the provider you have requested.
If we are unable to accommodate the above request, our scheduler will assign you to the next available appointment with the provider you have requested.
Insurance Information
Please upload an image of your insurance card(s).
If you are experiencing trouble uploading images, please enter your insurance information manually and bring your card(s) to your appointment.
Please upload the front and back of your insurance card(s).
Please manually insert the information below
Remember bring your insurance card(s) to the appointment so we can scan it in the office.
Example: BCBS, United Healthcare, Aetna, Medicare
Example: PPO, POS, EPO, HMO
Please note: if we are not contracted with your insurance, or we are unable to confirm your coverage, we will contact you directly.
State Requested Information
Texas law requires the Texas Department of State Health Services to collect information on the race/ethnic backgrounds of patients. Medical facilities are required to ask patients to identify their own race and ethnic backgrounds.
The data obtained through this process will be used to assist researchers in determining whether or not all citizens of Texas are receiving access to adequate health care.
You are NOT REQUIRED to answer the following questions. You may mark the choice that you are declining to answer.
Select the option that most accurately identifies the patient's ethnic background.
Select the option that most accurately identifies the patient's race.
Select the option that most accurately identifies the patient's preferred speaking language. This disclosure of information does not obligate Texas ENT Specialists, its providers and/or staff to communicate with the patient in his or her preferred language.
