Thank you for allowing us to participate in your care. To make your first visit go as smoothly as possible, please review and collect the following information to prepare prior to your visit:
- Your insurance card or insurance information (including policy number)
- Any x-rays, scans or pertinent lab work you have had for the condition for which you are seeing us (if possible, please bring the CD/DVD images and not just the paper report)
- Any pertinent medical records from your current physician
- The names of all of your current medications
- Your primary care physician referral form, if appropriate
New Patient Forms
There are 3 different forms required for all new patients of Kentuckiana Ear, Nose and Throat. These forms (listed below) can be printed on your home computer, and filled out at your convenience prior to your first appointment. Links will provide PDF copies of these forms.
- Patient Information / Authorization Forms
- Patient Medical History Form
- Kentuckiana ENT Office Policy
Please allow plenty of time to complete your required information, and plan to arrive at least 15 minutes early to your first visit to complete any additional information.
Any patient who arrives for an appointment without a referral (should their insurance require one) will have to be rescheduled to another date and time.
Please note, you will need to be prepared to pay your insurance deductible and your specialist co-payment amount on the day of your visit. Please contact your insurance carrier if you are unsure of your benefits.
We are proud to practice at multiple facilities throughout the region. Here is a partial list of the facilities at which we operate and have privileges:
- Baptist Hospital East and Baptist Health Eastpointe
- Clark Memorial Hospital
- Jewish Hospital/KentuckyOne Health and affiliates, including Medical Center East
- Kosair Children’s Hospital and satellite centers, including Kosair Children’s Medical Center – Brownsboro and St. Matthews
- Norton Brownsboro Hospital
- Norton Women’s and Kosair Children’s Hospital St. Matthews (formerly Suburban)
- Norton Hospital Downtown
Please call our centralized scheduling office during our normal office hours (8:30 a.m. to 4:30 p.m., Monday through Friday) at (502) 894-8441