Patient Forms and Policies
Office Information
Patient Forms
- Patient Registration (H&P)
- Medical Release Form
- What to Bring on your First Visit
- Two weeks prior to surgery. Drugs that cause bleeding problems
- Surgical Consent
- Confidentiality Agreement
- Patient Referral
- Sleep – Berlin Questionnaire
- Sleepiness Scale
- Post Operative Care for Microdirect Laryngoscopy
- Post Operative Care for Nasal Surgery
- Post Operative Care for Thyroidectomy
- Post Operative Care for Tonsillectomy and Adenoidectomy
- Cawthorne Exercises
- Tinnitus Handicap Inventory
- Meniere’s disease
ALL MAJOR INSURANCES ARE ACCEPTED
Aetna, Blue Cross | Blue Shield | Cigna | HealthCare Partners | Healthnet | Pacific Care | Prime Health Care | UHC | and Medicare.
We may still accept your insurance even if
it is not listed, so please call us.
We are not providers for Medi-Cal or
Workmans Compensation.
Office Financial Policies
Because of the recent changes in Healthcare our office policy has changed to accommodate these new changes. All patients must pay the estimated cost of their office visit including any office procedures at the time of the visit if the insurance policy deductible has not been met. Copays and/or co-insurances will also be estimated and must be paid at the time of the visit. This is done for your protection to allow you to estimate the financial cost of your healthcare at the time of your visit and to avoid any surprise obligations after care has been provided. You will be furnished with this information before you are roomed and the amount collected either before or after the office visit. Thank you for your understanding as we all adjust to our Nation’s Healthcare plans. Please call our office if you need more information or details regarding this policy.
HIPAA Privacy Policy
OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION
Foothill ENT Care understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care. This notices applies to all of the records of your medical care which are received or created by Foothill ENT Care.
Contact us
Call Us
(909) 599-6611
Email Us
info@foothillentcare.com
Our Location
Suite 101
San Dimas, CA 91773