Don Lerner, MD, FACS
Welcome to Baptist ENT Specialists. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.
Baptist ENT Specialists Forms:
Captures your insurance information and authorizes Baptist ENT Specialists to prepare and submit your medical bill directly to your insurance company.
This forms acknowledges that for certain procedures, you may be responsible to pay more than just the standard office visit co-payment or co-insurance.
Authorizes Baptist ENT Specialists to release information concerning the status of your health care and to discuss your treatment plan with an individual that you name.
This form provides acknowledgement about insurance and privacy policies and authorizes us to submit a bill to your insurance company.
This form is a financial policy disclosure for Baptist ENT Specialists.
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Requires Adobe® Acrobat Reader or Apple® Preview application. Click [ HERE ] to download and install the latest version of the Adobe® Acrobat Reader. Once you have the reader installed, you will be able to open and print the selected form.