Patient Information

Patient Forms and Requests

Below you'll find different options related to our patient forms and your requests. First you'll find our secure Online options. The Online options are followed by download options and additional "other" forms for download/print - choose your preference.

Effective 12/1/18, we will no longer collect cash at our locations for copays and other balances. We will continue to accept checks and all major credit cards.

NOTICE TO NEW PATIENTS: If you have an appointment and will be filling out your forms Online, please complete both the Patient Registration form AND the Adult (or Pediatric) Health History form.

Online Requests and Patient Forms

Online Requests

Please use our universal online request form to request an appointment, ask questions, medication refills, lab and test results, and medical records release.

Online Request Form

Patient Forms

New patients, please complete both registration and applicable health history forms. Current patients, please complete the health update form based on the instructions below.

Patient Registration Adult Health History Pediatric Health History

CURRENT PATIENTS - The form below is for any patient who was seen at SFOMG over 1 year ago but less than 2 years ago.

Adult Health History UPDATE

Download/Print Patient Forms

We also provide the option of download and print of our forms.

New Patients

We look forward to meeting you on your initial visit to our offices. Our completely electronic medical record allows us to provide you with the highest quality care and optimal communication with your other health care providers. In addition, we know that every patient is different and has specific needs, and we will strive to provide you with personal, individualized attention.

What to expect

ENT doctors, or Otolaryngologists, are trained in the medical and surgical treatment of patients with diseases and disorders of the ears, nose, throat (ENT), head, and neck. ENT is a subspecialty and requires specialized equipment to thoroughly examine and properly diagnose a patient’s complaint.

We understand that patients may be unfamiliar with these ENT techniques and equipment. Listed below is an idea of what to expect in an ENT consultation. However, not all of these methods will be necessary in every consultation and the techniques will vary given the individual needs of the patient and the nature of the complaint.

Please prepare for your visit by bringing:

  • Health Insurance Card/Information 
  • A list of all medications you are taking
  • A list of your questions /concerns
  • A copy of your XRAYS / CT scans (not just the reports - please get the actual films as well on CD if possible)
  • Copies of records from doctors related to your sinuses/nose/allergies/lungs on CD if possible.

Self - Assessment Questionnaires

If you think you are affected by any of the following conditions, please print the self-assessment test and bring completed form with you to your appointment.

Sinusitis or Nasal Allergies
Trouble Sleeping or Tiredness
Hearing Loss 
Hearing Handicap 
Ear Infection
Ringing in the Ears
Dizziness or Vertigo
Hoarseness or Speaking Difficulty

Patient Portal (Coming Soon)

Secure Patient Portal - We invite you to log in to your online account or create a new online account. Take advantage of the online services offered by our practice with the assurance that all of your information is encrypted and stored securely.

  • Access all online services offered by your physician
  • Update demographics and insurance
  • Update e-mail address
  • Update username and password
  • View history of previous visit

Billing & Insurance

We accept most PPO's, Medicare and Brown and Toland Medical Group HMO's. You will be responsible for ALL co-pays, deductibles and non-covered services. We accept Visa, Mastercard, and personal checks.

For questions regarding your billing statement and/or benefits, please contact the billing office:

Phone: 1 (800) 342-7447
Fax: (415) 883-0946

Insurance Information

Patient Electronic Health Record Notification

As part of our commitment to patients in providing the highest quality healthcare services, the physicians and staff of this office utilize an electronic health record (EHR) system. The EHR system allows our physicians and staff to consolidate, store, retrieve and share medical information about a patient’s medical history. The EHR is endorsed as a way to increase accuracy, improve efficiency and reduce medical errors. Medical records are created when you receive treatment from a health professional, as you do from our office. Records may include your medical history, details about your lifestyle (such as smoking or involvement in high-risk sports), and family medical history. In addition, your medical records contain chart notes, consultation notes, laboratory test results, medications prescribed, and reports that indicate the results of operations and other medical procedures. Information will be entered directly or scanned into a web based medical record system in the computer. This chart is connected to a network of local physicians and offices associated with the Brown & Toland Medical Group. The physicians in the Brown & Toland network are members of hospital staff at various hospitals including California Pacific Medical Center, Seton Medical Center, St. Mary’s Hospital and Saint Francis Hospital. Your medical records are shared in this network and may be accessed by other physicians within the system. In turn, this office has access to records generated by other network physicians who see you and these records are shared only where there is a treatment relationship. The EHR has levels of security to protect against inappropriate access or disclosures. We believe patient care will be enhanced by immediate access to information we might not know otherwise exists.

If you have any questions or concerns, please discuss them with your physician or call our office for further assistance.

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