Download New Patient Forms

1. ❖Please download our new patient forms by clicking here... NEW PATIENT FORMS
   

2. ❖Fill out all THREE pages and bring them with you to your appointment
   

3. ❖Bring along a photo ID
   

4. ❖Also bring your insurance card
   

Our privacy practices are also available and can be viewed here...  Notice of Privacy Practices

These forms are in PDF format and you may already have the software needed to view and print the forms. If not, you will need to download and install Adobe Acrobat Reader. Please be patient these files may take several minutes to download and view on your computer.

(386) 774-9880                    © 2006 Atlantic Ear, Nose & Throat, PA                    (407) 444-5225

Devang M. Shah, M.D.

Daniel Rothbaum, M.D.

Natasha Taylor, PA-C