Patient Forms
At Central Park Ear Nose & Throat (CPENT), we value every patient’s time. Your appointment time is the time set aside to see your doctor. We would like to work with you to efficiently prepare and maximize your one on one time with the doctor. Preparation may eliminate delays in treatment and diagnosis or the need for return appointments.
Central Park ENT offers Electronic Medical records (EMR) that allows us to electronically send prescriptions, accept payments on line, and provide real time information to both our physicians and patients’ primary care physicians.
Please allow extra time before your appointment time to allow our staff to assist you in our Electronic Medical portal check in.
How Can You Help?
- Make your appointment by contacting the office at (817)261-9191, option 1, or fill out the contact form and someone from our office will contact you.
- Bring your Insurance card and Driver’s License.
Information for Your Procedure
- ENG Instructions “ENGLISH”
- ENG Instructions “SPANISH”
- Cancellation Policy
- Allergy Packet
Miscellaneous Information
- Hippa Info ENT
- Authorization to Disclose Health Information
- One Minute Satisfaction Survey
- Authorization Form for Release of Protected Health Information
- Patients whose insurance requires a referral, please be sure the office has received the referral at least 24 hours before your appointment.
- Complete the Online Forms relative to your appointment.
- Established Patients must update forms every 6 months.
- Bring ANY previous test results of lab, pathology, x-rays, sleep studies, or anything pertinent to your treatment. Sinus CT films should be brought in addition to the report. Previous allergy testing information is extremely important as well as previous audiometric (hearing) tests; abnormal school hearing test results should be included.
- Please type your list of medications into the portal as instructed along with dosages and frequency of which they are taken please include over the counter medicines or herbal supplements.
- Bring someone to care for other siblings, if you are bringing a child, so that you and your doctor can focus on the needs, care, and treatment of the child being treated.
- Bring a list of any questions you or any concerned family member may have.
- If there is special concern about parent or step-parent access to patient information, please bring a copy of the court order when appropriate.
- Students covered by insurance that requires full time student status, bring Proof of Full Time Student Status.
- Patients with new insurance should bring Proof of Prior Coverage Form, when appropriate, to prevent claim denial for Pre-Existing clause.
- All non-English speaking patients or hearing impaired patients should bring a translator with them (Todos los pacientes que no hablan Ingles, Favor de traer a un traductor).
- Patients having an ENG MUST read the ENG letter 48 hours prior to the appointment.
- If you (adult) are having a hearing test and care for young children (under the age of 10), please arrange for another person to care for your child during your hearing test.
- If only 1 child is having a hearing test and you have other children under the age of 10, please arrange for another person to care for the other children during the hearing test.
- Your appointment time for the hearing test or ENG is when we bring you back to start the evaluation.
- Please bring a translator with you for the hearing testing or ENG if needed.
