(423) 929 - 9101
2340 Knob Creek Road Suite 704 Johnson City, TN

    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 Information Authorizationpdf-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