{"id":466,"date":"2021-06-08T12:03:57","date_gmt":"2021-06-08T17:03:57","guid":{"rendered":"https:\/\/entmidwest.fm1.dev\/?page_id=466"},"modified":"2024-11-26T11:13:12","modified_gmt":"2024-11-26T17:13:12","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/entmidwest.com\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n

New Patient Information<\/h2>\n\n\n\n

Please plan to arrive 15 minutes prior to your scheduled appointment time. Bring your driver\u2019s license, medical insurance card(s), insurance referral if needed, and your co-pay for seeing a specialist, if applicable. Please bring any related medical records, test results and imaging films that should be given to the doctor.<\/p>\n\n\n\n

Patient forms are available for download below. Please print out and complete the Patient Registration and Medication forms to bring with you to your appointment. There may be additional forms for you to complete upon your arrival.<\/p>\n\n\n\n

First Visit Forms<\/h2>\n\n\n\n

Thank you for choosing Midwest ENT Centre. We’re excited to see you.<\/p>\n\n\n\n

To make your first visit more enjoyable, please print and fill out the following forms before your appointment, so we can expedite your time in our waiting room:<\/p>\n\n\n\n

Patient Registration Form<\/a>Download<\/a><\/div>\n\n\n\n
Minor New Patient Registration Form<\/a>Download<\/a><\/div>\n\n\n\n
Minor Consent Form<\/a>Download<\/a><\/div>\n\n\n\n
Medications List<\/a>Download<\/a><\/div>\n\n\n\n
Privacy Practices Pamphlet<\/a>Download<\/a><\/div>\n\n\n\n
Know Your Rights Documentation<\/a>Download<\/a><\/div>\n\n\n\n
In-office Procedure Consent Financial Info<\/a>Download<\/a><\/div>\n\n\n\n

For release of your medical records, please print out and complete the following form:<\/p>\n\n\n\n

Medical Records Release Form<\/a>Download<\/a><\/div>\n\n\n\n

Patient Portal Forms:<\/h2>\n\n\n\n
Patient Portal Registration Instructions<\/a>Download<\/a><\/div>\n\n\n\n

Instructions to create a proxy account so you can access your child or dependent adult\u2019s portal account:<\/p>\n\n\n\n

Patient Portal Proxy Registration Instructions <\/a>Download<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

New Patient Information Please plan to arrive 15 minutes prior to your scheduled appointment time. Bring your driver\u2019s license, medical insurance card(s), insurance referral if needed, and your co-pay for seeing a specialist, if applicable. Please bring any related medical records, test results and imaging films that should be given to the doctor. Patient forms…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"service_tags":[],"class_list":["post-466","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/pages\/466","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/comments?post=466"}],"version-history":[{"count":18,"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/pages\/466\/revisions"}],"predecessor-version":[{"id":2713,"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/pages\/466\/revisions\/2713"}],"wp:attachment":[{"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/media?parent=466"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/entmidwest.com\/wp-json\/wp\/v2\/service_tags?post=466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}