- 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 several different forms required for all new patients of Kentuckiana Ear, Nose and Throat. These forms are combined into one document. These forms can be printed on your home computer and filled out by hand at your convenience prior to your first appointment. Or, they can be downloaded and filled out on your computer by typing in the appropriate fields and printing. Link will provide a downloadable PDF copiy of these forms.
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 that may be required.
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