ENTJC Forms & Notices

Save Yourself Some Time!

Please print, complete, and bring these forms with you to your ENT appointment. We look forward to seeing you!


Patient Registration Form pdf-icon


HIPAA Authorization Consent Formpdf-icon


Patient Health History Formpdf-icon


Minor Patient Treatment Consent Formpdf-icon


Notice-of-Privacy-Practicespdf-icon


Release of Healthcare Informationpdf-icon


Notice of Nondiscriminationpdf-icon

No printer? No problem – we can mail these forms to you, just call (423) 929-9101 or Email your request to ContactUs@ENTJC.com and we will be happy to accommodate.

Request Your Appointment