Forms

Posted on May 14, 2020 by Southeast Texas Ear, Nose & Throat

Bill Pay

Pay Bill Online

ENT Center Forms

General Patient Information Download

Notice of Privacy Practices Download

Review of Symptoms Download

New Patients Download

Facial Plastics Center Forms

New Patient Form Download

Notice of Privacy Download

Patient Consent Form Download

Patient History Form Download

Patient Photography Release Form Download

Patient Waiver Form Download

Laser Pre-instructions Download

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If you are experiencing a medical emergency, please call 911. To request an appointment or connect with our team, please complete the form below. Our team will contact you during our regular business hours.

ENT	(409) 212-8111
Allergy Center	(409) 981-1777
Facial Plastics Center	(409) 212-8121
Hearing Center	(409) 981-1700

ENT	(409) 853-1363
Hearing Center	(409) 853-1363