Call us directly: 602.688.6500

Bell Rd, Phoenix: View Location

Union Hills Drive, Glendale: View Location

Our Forms

New patients are required to complete Patient Registration and History and Physical forms before their initial examination. We encourage patients to complete these forms at home and bring them to their first office visit.

When you click on the form name below, your browser will open Adobe Reader. Select Print from the Adobe menu bar. If you do not have Adobe Reader 3.5 or later on your computer, you may download it at no charge.

For Your Appointment

For Your Appointment, We Will Need

  • Any relevant diagnostic test results or x-rays
  • Your insurance card. We will make a copy of it for your patient chart
  • Please bring a government-issued photo ID to all New Patient appointments
  • Most insurance plans require co-payment at the time of service, so be sure to bring it with you. Our office accepts cash, checks, Mastercard, VISA and American Express.
  • Bring referral forms if required by your insurance
  • Inform our office and your insurance company of any address or telephone number changes
  • If you are not insured or need to meet a deductible, our staff will be happy to work with you to make payment arrangements.


What About Insurance?

Medical care has never been as advanced as it is today, nor has it ever been so complicated. The typical doctor’s office maintains relationships with dozens of insurance companies, managed care organizations, primary physician’s organizations and other payers. Each has its own set of requirements concerning payment, patient co-payment and pre-authorization requirements.

We want to work with you to assure that the care you receive is consistent with your insurance provider’s requirements. Since you, as the patient, are financially responsible for the cost of the care we provide you, North Valley ENT believes it is in your best interest to be actively involved with your insurance provider through this process. We encourage you to learn about your benefits and their limitations. Be prepared to pay your insurance co-payment, if your plan requires one. It is also wise to be informed of any benefit restrictions due to pre-existing conditions. Find out if you have a deductible and whether or not it has been met, so you will be prepared if necessary to pre-pay some of the cost of your surgery.