go Having your registration forms completed prior to your visit is helpful to being seen at your scheduled appointment time. Your appointment time is based upon your forms already being completed. If you need our assistance, please arrive 30 minutes early so we can have a staff member aid you. 

Patients who need to reschedule their appointment or to request a follow-up appointment may do so by calling our office. 

Notice Informing Individuals About Nondiscrimination and Accessibility Requirements Atlantic Ear, Nose & Throat, PA’s, Please click the link below,

 Nondiscrimination Statement

Patient Forms

These forms should be printed and filled out prior to your first visit with us, or anytime your information or medical status has changed.  Bring them with you, or you may mail them back in advance of your visit. Your appointment time is based upon your already having these forms completed. 

In order to view or print these forms you will need Adobe Acrobat Reader installed.  Click here to download.

What to Bring To Your Appointment

  • Completed New Patient Forms (all 4 pages - all blanks will need to be filled out before your visit)
  • A photo ID for adult patients, photo ID of the parent/guardian for children
  • Medical insurance card
  • Any prior relevant test reports, films, imaging studies, surgical reports, etc.
  • A list of questions or concerns
  • A caregiver who can help you make decisions if you are unable to do so
  • Payment for any deductible, copayment, or coinsurance as required by your health insurance carrier

Special Note: If a child is brought by an adult that is not a parent or guardian, a letter giving authorization must accompany them or can be faxed in advance to our office (FAX: 386 - 774 - 2898).
Please contact our office to speak with our Patient Service Representatives for more information regarding special instructions and documents needed for the appointment. Office: (386) 774-9880. You are welcome to use our consent form below.

Special Note: If an impaired adult is brought by someone other than the Power or Attorney or Healthcare Surrogate, please contact our office to speak with our Patient Service Representatives for more information regarding special instructions and documents needed for the appointment. Office: (386) 774-9880. You are welcome to use our consent form below.

Special Note: Nursing home patients should have their paperwork faxed to us in advance of the patient's visit.  (FAX: 386 - 774 - 2898) 

Special Note: Nurse Case Managers who wish to accompany a workers' compensation patient to their visit and have a conference with the physician should contact our office to arrange this in advance so that appropriate time can be blocked in the schedule. Requests at the time of the appointment cannot be accommodated.