{"id":340,"date":"2019-06-20T14:18:33","date_gmt":"2019-06-20T18:18:33","guid":{"rendered":"https:\/\/easterncarolinaent.fm1.dev\/patient-forms\/"},"modified":"2024-12-05T14:24:41","modified_gmt":"2024-12-05T19:24:41","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/easterncarolinaent.com\/resources\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n

By providing our Patient Forms Online, this allows you the opportunity to fill out and bring with you. This lessens wait time before seeing your physician.<\/p>\n\n\n

\n

Click on a Form Name to Download and Print Form.<\/h2>\n
Patient Information Form<\/a>Download<\/a><\/div>\n \n
Patient History and Physical Form<\/a>Download<\/a><\/div>\n \n
Patient Medical Release Form<\/a>Download<\/a><\/div>\n \n
Notice of Privacy Practices<\/a>Download<\/a><\/div> \n \n
Acknowledgement of Privacy Practices<\/a>Download<\/a><\/div>\n \n
Notice of Nondiscrimination & Accessibility Statement<\/a>Download<\/a><\/div>\n\n<\/div>\n\n\n\n
\n

Low Level Vision Patient Forms<\/h2>\n
Patient Information Form<\/a>Download<\/a><\/div>\n
Patient History and Physical Form<\/a>Download<\/a><\/div>\n
Patient Medical Release Form<\/a>Download<\/a><\/div>\n
Notice of Privacy Practices<\/a>Download<\/a><\/div>\n
Acknowledgement of Privacy Practices<\/a>Download<\/a><\/div>\n
Notice of Nondiscrimination & Accessibility Statement<\/a>Download<\/a><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

By providing our Patient Forms Online, this allows you the opportunity to fill out and bring with you. This lessens wait time before seeing your physician. Click on a Form Name to Download and Print Form. Patient Information FormDownload Patient History and Physical FormDownload Patient Medical Release FormDownload Notice of Privacy PracticesDownload Acknowledgement of Privacy…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":113,"menu_order":113,"comment_status":"closed","ping_status":"closed","template":"","meta":{"schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":"","footnotes":""},"service_tags":[],"class_list":["post-340","page","type-page","status-publish","hentry"],"yoast_head":"\nPatient Forms - Eastern Carolina ENT Head & Neck Surgery<\/title>\n<meta name=\"description\" content=\"252-752-5227 | By providing our Patient Forms Online, this allows you the opportunity to fill out and bring with you. 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