Forms & Policies
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Download Patient Forms
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
- Patient Registration – ENT & Audiology
- Patient Registration – Allergy/Immunology
- HIPAA Privacy Notice – print only for your records
- Established Patients – Yearly Update Forms
Appointments can be made by calling our office during normal business hours. For ENT Clinic and Audiology our hours are: Monday – Thursday, 8:00 a.m. till 5:00 p.m. and Fridays from 8:00 a.m. till Noon. The Allergy Clinic hours are Monday – Thursday, 9:00 a.m. till 4:30 p.m. On Friday the Allergy Clinic provides allergy shots by appointment only until noon.
After Hours & Emergency Care
If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week by calling: 309-677-6084.
- Please contact your pharmacy directly in order to receive your medication in a timely manner
- Contact your pharmacy two to three days before your prescriptions run out
- When contacting your pharmacy for prescription refills, you may need the prescription number that is printed on your prescription bottle label
- In some instances, we may require that the patient be seen in our office prior to medication renewal
All office visit co-pays are payable at the time of service. If you are covered by an insurance plan for which we are an in-network provider we will submit insurance claims for you (unless you specifically opt out of this service). However, the agreement of the insurance carrier to pay for medical care is a contract between you and the carrier and you should direct any questions and/or complaints regarding coverage to your insurance carrier, your employer (if in a group plan) or your insurance agent. Co-pays for office visits only cover the base visit and evaluation. They do not cover any additional testing or in-office procedure our medical staff may perform during your visit. Account balances are due within 30 days of when the bill is issued. Bills will be issued after the insurance carrier pays its portion of the bill. Insurance plans vary in their coverage and it is the patient’s responsibility to understand his/her medical benefits. The patient portion is set by the insurance company and the patient remains responsible for any co-insurance, deductibles and any other non-covered billable services. We accept cash, checks, and most major credit cards and debit cards. Please contact our billing office during normal office hours should you have any financial questions or concerns.