You can now download new patient forms from our website before you come in for your office visit and save time!
Please remember to bring your insurance card with you at the time of visit. Charlotte Eye Ear Nose & Throat Associates participates with most major insurance plans. To verify participation in your plan, please contact us at (704) 295-3000 or or call your insurance provider.
New Patients to our practice should complete the following new patient forms:
- Demographics Form & Medical History Questionnaire Form
- Uveitis Questionnaire : For new uveitis evaluation patients
Voice & Swallowing Patients:
Patients With Caregivers:
To review our policies, please download the following forms:
- Financial Policy
- Release of Information Form - Please allow 7-10 business days to receive a copy of your medical records. The fax number is 704.295.7794.
- Permission to Treat Form
For a list of our services that are not covered by insurance, please download:
(Adobe Acrobat is required to view these forms. If you would like to download a free copy of Adobe Acrobat Reader, please go to http://get.adobe.com/reader/)