Patient Resources

Office Hours:

Monday through Wednesday 7:30 am – 5:00 pm and Thursday through Friday 8:00 am – 5:30 pm.
Phones are answered Monday through Friday 8:00 am – 5:00 pm. Patients are seen by appointment only.

We accept most insurance plans. Please contact our office and see if we participate with your plan.


General Office Policies:

PAYMENT FOR SERVICE IS DUE AT THE TIME SERVICES ARE RENDERED: We accept cash, personal checks and major credit card (Master Card, VISA and Discover).

INSURANCE: The doctor’s service is provided directly to you and not to an insurance company. We cannot render service on the assumption that the charges will be paid for you by the insurance company. If we participate with your insurance, we will file your services directly to them. You will be expected to pay any deductible and/or co-pay as outlined in your policy when you check in on your appointment day. We must emphasize that, as your medical providers, our relationship and concern is with you and your health, not your insurance company. All Charges are your responsibility from the date services are rendered.

AUTHORIZATION FOR SERVICES: The patient is responsible for all authorizations for services before services are rendered. If we do not have an authorization number at the time of your visit, you can either pay for services in full, or reschedule your appointment. Patients are also responsible for letting us know which lab their insurance requires us to use for any laboratory work. We will not be held responsible.

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Discrimination is Against the Law

Brevard Ear, Nose and Throat complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Brevard Ear, Nose and Throat Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Brevard Ear, Nose and Throat Center:
•Provides free aids and services to people with disabilities to communicate effectivelywith us, such as:                                                                   ○Qualified sign language interpreters                                                                                                                                                                         ○Written information in other formats (large print, audio, accessible electronic   formats, other formats)

•Provides free language services to people whose primary language is not English, such  as:                                                                                ○Qualified interpreters                                                                                                                                                                                                    ○Information written in other languages

If you need these services, contact Shanna, Brevard Ear, Nose and Throat Civil Coordinator.
If you believe that Brevard Ear, Nose and Throat Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Office of Civil Rights 1317 Winewood Blvd., Bldg 1, Room 110Tallahassee, Florida 32399-0700, Phone 850-487-1901, Fax 850-921-8470, and TTY 850-922-9220 is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201  1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Last updated 10/2016-SL


New Patient Forms

To save time during your visit, please fill out these two online forms at least 24 hours prior to the day of your appointment. If it’s less than 24 hours, please arrive at the office 30 minutes early to complete these forms. Please be prepared to provide this information to our office along with your current medical insurance information. Once you submit your paperwork through our website it becomes encrypted and is secure.

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Records Release Form

The following Patient Records Release Form can be downloaded to your computer and printed at home if you need to request your medical records. If you have any questions when filling out this form, please do the best you can and our staff will assist you with your questions on the day of your visit.

Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

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