If you would like to make an appointment please call our office Monday – Friday from 8:30 am to 12:00 pm and 1:00 pm to 5:00 pm at 910.323.1463. Or send us a request for an appointment using our online contact form.
Patient Registration Forms
When you have made an appointment you may pre-register by selecting the links below for our office forms. Once completed you can click the submit tab at the bottom of the page and it will be emailed to us. Submitting the forms prior to your arrival will help to get you in to see the physician faster. If you are unable to keep your scheduled appointment you MUST give us a 24 hour notice to cancel or you will be charged a $30 fee which will not be covered by any insurance that you may have.
- Patient Registration Form
- Notice of Health Information Practices
- Patient Financial Policy
- Consent to Treatment
- Medical Records Consent Form
You may submit the forms below online to us or print and bring with you:
If you are having dizziness or any hearing loss you may want to complete these additional forms:
If you have had any x-rays, CT’s, MRI’s or other studies that pertain to your visit with us, please bring them with you to your appointment. Also, bring any medical records you may have from your primary care doctor and all of your medications.
Fayetteville Otolaryngology will accept most major insurances. To inquire about insurance that you may have, please call to speak with one of our insurance specialist’s at 910.485.5996 during normal office hours.
If we are providers for your insurance company, we will try to let you know an estimated amount that you are expected to pay at the time of service. If we are not a provider for your insurance company, we will gladly file your claim as a courtesy to you when services are paid in full.
We DO NOT see minor children without a parent or legal guardian on the initial office visit. On return visits minor children must be accompanied by an adult.