NEW PATIENT PAPERWORK
Please complete before your appointment.
Welcome to Nashville ENT and Allergy Clinic. We are committed to professional specialty care using a collaborative team approach, state-of-the-art electronic information and medical technology, and the convenience of a single location for our services. Please help us prepare for your appointment by completing the Patient Registration form below.
Mitchell K. Schwaber, M.D.
Matthew T. Speyer, M.D.
IMPORTANT INFORMATION
Important Information
- In order to expedite your check-in, please complete the form below prior to your scheduled appointment. Please make sure you have your insurance cards(s) and picture ID with you. If your insurance requires a referral to a specialist, it is your responsibility to contact your primary care physician and have the referral sent to our office before your appointment date. They may fax this to 615-386-2197.
- Insurance co-pays or out-of-pocket amounts that may have been quoted to you are due upon arrival for your appointment. If you cannot pay this amount at the time of the appointment, we may ask you to reschedule.
- If you have previous records pertaining to your condition, such as test results, x-rays, MRI or CT scans, hearing or balance tests, please make sure that you bring copies of these to your appointment, and you may be asked to repeat these tests or have your referring doctor send them to us. Failure to obtain these may create a delay in being seen. We will not be able to obtain these records at the time of your appointment, and you may be asked to repeat these tests.
- If you have an appointment for hearing loss, dizziness or tinnitus, you will first see an audiologist for testing. Please arrange your schedule and allow for this appointment to last for two to three hours.
- If you need to cancel your appointment, we require 24 hours’ notice. Failure to meet this notice, or no-showing for your appointment, may result in a $50 charge. Please note that if you arrive late, you may be asked to reschedule your appointment.
PLEASE BRING PHOTO ID, INSURANCE CARDS AND MEDICATION LIST.
Medical Plaza East, Suite 400
4230 Harding Pike, Nashville, TN 37205
Phone: (615) 386-9089 Fax: (615) 386-2197