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Forms & Appointment

 

Before your appointment with us, you can quickly and conveniently filled out these patient forms to facilitate your visit. 

 

To view the forms listed below, you will need Adobe Reader. If you do not have Adobe Reader, you can download the free version by clicking on the Acrobat Reader icon below.

 

Please bring your completed forms with you to our office at the time of your visit.

 

                 Registration Forms

                

                 Medical History Form

                 

                 Privacy Policy

 

In addition to these forms you will be responsible for 
bringing the following:

- Current Photo ID

- Insurance Card

- Referral if required by your insurance

- A list of all medications you are taking

- A list of your questions and concerns

- A copy of your Xray or CT scans (Both reports and actual films would be helpful)

- If you have Power of Attorney over the patient, you are required to bring all the necessary paperwork to the appointment.

It is required by law for all minors to have a parent or guardian with them to be seen. If the parent or guardian is unable to accompany the patient to their appointment, they must have an authorization stating who may bring the patient to their appointment.

 

Office Policies 

 

Appointments

Appointment are made by calling our office during normal business hours. Same day appointment may be available depending on availability.

 

After Hours & Emergency Care

If you are experiencing an emergency, dial 911 or go to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week.

 

Prescription Renewals

Should you need a prescription refill, simply call the office and the nurse will check with the physician. Before calling please have the following information ready: name, birth date, drug name, and pharmacy telephone number. Please note that narcotics and other controlled substances can not be called in after normal office hours. On certain cases, we may require that the patient be seen in our office prior to medication renewal.

 

Billing & Insurance  

We participate in most PPO and managed-care national insurance plans. We are also providers for most local medical groups in the area including Regal Medical Group, PrimeCare, San Bernardino Medical Group, Alpha Care Medical Group, Pinnacle Medical Group, IEHP, and others. Some of the insurance plans with which we participate include: Blue Cross, Blue Shield, Medicare, Mail Handlers, United HealthCare, Aetna, Cigna, Beech Street, PHCS, Exclusive Care, and others.

We will file your insurance claim for you. In all cases should you require surgery or hospitalization we will assist in processing your insurance claims. For surgery patients, many insurance plans today require medical pre-authorization prior to your surgery. If your insurance requires pre-authorization, our office will discuss this with you.

All office visits are payable at the time of service. We accept cash, checks, and most major credit and debit cards. If you have any questions regarding billing, please contact our billing office at (951) 738-0968 or (951) 738-8217.

 

Privacy Policy

We are committed to the right to privacy for our patients and web site visitors. If you have any questions about our privacy policy, please contact us or visit our privacy pages.

ENT & Sinus Center, 8241 Rochester Ave, Ste. 130, Rancho Cucamonga, CA 91730 - Office (909) 466-8400 * Fax (909) 466-8410
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Copyright 2016 ENT & Sinus Center, P.C. * Privacy Policy * Disclaimer