Patient Information

Patient Forms

Simply download the New Patient Packet below, print it out and fill it in. Bring the completed forms to any of our locations at your appointment to reduce your wait time.

Medical Records Release Form ->

Notices and Policies

Language Assistance Services Notice ->

Nondiscrimination Statement ->

Notice of Nondiscrimination ->

Notice of Privacy Practices ->

You will need Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, you can download it here.

What Insurance Plans Does the ENT Institute Take?

Please contact us to confirm coverage for a specific location or provider

AARP Supplement
Accordia
Amerigroup
Allwell from Peach State
Smith Administrators
South Care
Ambetter from Peach State
Peach Care
Performax
Assurant
Care Improvement
Campus/Tricare
Caresource
Multiplan
Definity
CCN
Coventry Medicare
Core Source

Cigna Medicare
Cincinnati Life
First Health
Echo
Evercare (UHC Medicare)
GBHS Employees
Fiserv
Fortis
Group Administrators
Golden Rule (UHC)
Great West (part of Cigna)
Mamsi
Humana Wellstar
Lumenos
Mega LIfe/PHCS
Medicare
MediPlus
Peach State (Medicaid)

Mutual of Omaha
NYS HIP
Tricare (Humana Military)
State Health
Time Insurance
Tricare (Humana Military)
Tricare (Humana Military)
Tricare Prime
Tricare Select
Tricare for Life
Tricare (Humana Military)
Unicare
Tricare Reserve Select
UMR
Wausau Benefits
United Healthcare/ UHC Chip plan (medicaid plan)
UHC Navigate

Provider Plan
Aetna HMO, PPO, POS, EPO, & Promina – Not Par: Emory Choice
Aetna Aexcel Not a preferred Provider for 2014 Aexcel (higher co-pay/ deductibles applies)
Beechstreet PPO
BCBS/Blue Choice HMO, PPO, POS, Indemnity, Medicare, Direct, EPO, Anthem
Cigna HMO, PPO, POS, Medicare, Health Spring, NOT PAR: Local Plus
Coventry HMO, PPO, POS
Group Resources PPO
Guardian PPO
Humana & Humana Military (Tricare) HMO, PPO, POS, Gold
Humana Gold Medicare HMO policy
Kaiser PPO ONLY,(NO HMO/POS)
Medicaid Wellcare, Amerigroup,Peachcare,Peachstate
Medica UHC network
PHCS (Private Health Care System PPPO, POS
Principle/Southcare PPO, HMO, Promina NOT PAR: Principal Edge
Wellcare medicaid and medicare