Patient Registration

Please complete the Patient Registration Form before coming in for your appointment. If any patient information has changed since your last visit, for example, your insurance carrier or your address, please complete another Patient Registration Form as well.

If you are a new patient or if you have not been to our office in 2 years, please fill out the New Patient and Long Term Follow-up Patient Information form in addition to the Patient Registration form.
 If you are having a minor child brought to the office, and the parent or legal gaurdian will not be present, please fill out the Authorization for Consent to Medical Treatment for a Minor.

               Authorization for Consent to Medical Treatment for a Minor

If your minor child is unaccompanied, please fill out the form below.

 Authorization for Consent to Medical Treatment for Unaccompanied Minor

Thank you

 Carolina Ear Nose & Throat Head and Neck Surgery Center


Any information provided on this web site should not be considered medical advice or a
substitute for a consultation with a physician. If you have a medical problem,
contact your local physician for diagnosis and treatment.

© 2005 Carolina Ear, Nose & Throat, Head and Neck Surgery Center