Patient Resources & Documents

Ear, Nose, & Throat Clinic of Coffee County offers a variety of resources for patients to improve the quality of your experience. We are dedicated to providing you with the best possible medical care available.

We ask our patients to fill out a Patient Information Form annually, so we can keep our contact and insurance records up to date. To help us serve you better, you can download, print, and fill out this form at home before you arrive. Bring the completed form to your appointment to shorten your wait time.

Our Credit Policy document describes our fee and payment policies for all patients, with or without insurance. In an effort to avoid any misunderstandings, we ask that all patients read and sign this credit policy. You may download and print this policy, then read and sign it before your appointment to save time in the office.

Ear, Nose, & Throat Clinic of Coffee County's Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

If you ever need to request Ear, Nose, & Throat Clinic of Coffee County to release your protected health information for any reason, we will need you fill out and sign an authorization form for this request. Download and print, then fill out the Authorization to Disclose and Patient Request for Access to Protected Health Information form. You can drop off the completed form at your clinic office, or fax it to the number shown at the top of the form.

Downloadable Forms:

You'll need the free Acrobat Reader program to view some of these documents. You can download and install the program from the Adobe website here.


Authorization to Disclose Authorization to Disclose (49 KB)

Credit Policy Credit Policy (115 KB)

New Patient Paper Work New Patient Paper Work (346 KB)

Patient Information Form Patient Information Form (138 KB)

Privacy Practices Privacy Practices (64 KB)