Before your first appointment, please download and fill out your medical forms. You may also call our office to mail you these forms.

Click on the forms below to download or print. 

• Financial Policy
• Patient Information
• Health History
• Current Symptoms
• Notice of Privacy Practices
• Acknowledgment of Receipt of Notice of Private Practices
• Records Release

We only see patients on an appointment basis. If you need to cancel your appointment, please notify our office 24 hours in advance. We reserve the right to charge for appointments, procedures and surgeries cancelled or broken without 24 hours advance notice.

Please bring any relevant medical records with you, including:

• prior hearing tests
• recent lab results
• prior MRI or CT scan reports and images

Insurance and Payment

We verify your insurance prior to your appointment. You will be responsible for any co-payment or deductible at the time of your visit. If you do not have insurance, please be prepared to pay in full for your services. Our office accepts cash, checks, Visa and MasterCard. We also offer CareCredit for patients who desire a payment plan for services.

Orange Coast ENT Head and Neck Surgery is a contracted provider with the following insurance plans: 

PPO Plans

• Aetna
• Anthem
• Blue Cross
• Blue Shield
• Health Net
• Humana
• Medicare
• United Healthcare
• UMR 

HMO Plans (referral required)

• Hoag Affiliated Physicians
• Prospect