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Patient Forms
We have posted our Financial/HIPAA Forms and our Patient Intake Form for your convenience. Filling these out in advance will greatly expedite your visit with Mass. ENT Associates. We ask that you open, print, and fill out both the
Financial/HIPAA Forms (3 pages) and the Patient Intake Form (2 pages). (The
Notice of Privacy Practices referred to on the third page of the Financial/HIPAA Forms may be found on the
HIPAA page of this website).
Please note that at the request of our patients we have made the Patient Intake Form interactive - when you open it with Adobe Acrobat Reader, you can type directly into the fields as well as check off the appropriate boxes. At the end of the form is a Print Form button, or you can use the print button in the Acrobat Reader tool bar. If you want to clear the entire form, there is a Reset Form button at the end (please click this only if you want to clear all the fields and check boxes). Please note that the information typed into these forms is not submitted to us electronically and is not sent over the internet (you must bring the printed form with you to your visit). If you prefer to fill the form out by hand, you may simply print the blank form using the Print Form button or the print button on the Acrobat Reader tool bar.
(Adobe PDF
-These forms will open in a separate window. Some users may need to turn off their Pop-up Blocker to allow the new window to open).
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We recommend using the latest version of Adobe Acrobat
Reader (9.0) which will allow you to highlight the fields on the form - Click on
the image below to download the lastest version.
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