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We are pleased that you have chosen The Ear Center of Greensboro, P.A. for your medical and surgical care. Below are two forms, a Registration Form and a Medical History Form (available in either Microsoft Word or Adobe PDF format) for you to complete prior to your visit. We suggest that: (1) you download both forms, in either format, to your computer by clicking on the links below, (2) print out the forms, (3) complete the forms, and (4) bring the completed Registration Form and the Medical History Form with you to your appointment (best option). If you want to use your word processor to complete the forms, PLEASE USE "BOLD CAPITAL LETTERS" to complete the forms. Then, print out the completed forms, bring them with you to your visit, fax to us at (336) 273-9936, or mail them to us using snail mail (mail to : The Ear Center of Greensboro, P.A., 1126 N. Church Street, Suite 201, Greensboro, NC 27401). At the present time, there is no option to email them to us. Please leave ample time for delivery if you are using regular U.S. mail. Three Options:
Due to ever increasing medical costs, we request payment for office services at the time that the services are rendered, unless you are covered by an insurance plan with which we participate (see section entitled "Health Plan Participation" for a list of plans). If you belong to a managed care or HMO program that requires a referral, you must present a valid written or verbal authorization before being seen by our doctors. As specified by your insurance company, co-payment and deductibles are due at the time of your office visit.
Heath Savings Accounts (HSA's) Health savings accounts or HSA's are becoming more popular. Due to the high deductibles often associated with HSA's, we do ask that all visits be paid in full at the time of service. If you have met your deductible, please bring to your visit your latest "explanation of benefits" (EOB) from your insurance company. If your deductible has not been met, please be prepared to pay in full at the time of check-out. To make payment easier for you, we do accept Visa and Master Card for payment.
Due to North Carolina state law, we require that a patient, who is a minor (defined in NC as a child who is under the age of 18 years), be accompanied to all appointments by a parent or legal guardian. This is necessary before any evaluation or treatment can be performed by our physicians. A 17 year old child, who is able to drive, still needs to have a parent or legal guardian in attendance or non-emergent care cannot be provided.
Primary Care Prior Authorization
Depending on your plan, you may require prior authorization from your primary
care doctor. It is the patient's responsibility to obtain the prior
authorization. If you are unable to obtain the prior authorization, please
notify us in
Because of an increase in missed appointments for both new and return patients, a $30.00 fee will be billed for missed appointments for which we have not been notified within 24 hours. If you are unable to keep your scheduled appointment for any reason, please contact us at (336) 273-9932 so that we may make that appointment time available to other patients
Our office, The Ear Center of Greensboro, P.A., is located on the second floor of the "Church Street Medical Building", 1126 N. Church Street, Suite 201. The "Church Street Medical Building" is located directly across the street from the Moses Cone Hospital Cone Day Surgery Center. A large, free, convenient parking garage is located directly behind the building. The entrance to the building is on the parking garage side. All access is handicap accessible and wheel chair friendly. A covered portico is available for your convenience during inclement weather. Click here for a Map and Directions to The Ear Center of Greensboro, P.A.
Thank you for choosing us for your specialty medical and surgical care. Our entire staff looks forward to seeing you soon! You may call us at (336) 273-9932 for any questions.
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DISCLAIMER: Please note that this web site is not designed to, and does not, provide medical advice. All of our content, including text, graphics, images, photographs, charts, maps, information, etc. that has been made available on or through this web site, is provided for general information purposes only. The content is not intended to be a substitute for obtaining professional medical advice, diagnosis, or treatment. Do not delay in seeking medical advice and do not disregard professional medical advice once obtained because of information that you have obtained on this web site. It is a good idea to never rely on information from this web site, or any web site, in place of seeking up-to-date, professional medical advice. For additional information, please see our main Disclaimer Page.
Copyright © 2009 by The Ear Center of Greensboro, P.A. All rights
reserved.
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