The physicians and staff of Piedmont Ear, Nose & Throat Associates, P.A. (PENTA) want to welcome you to our practice. Our hope is that your visit to our office is as pleasant and stress-free as possible. Therefore, we ask that you complete the on-line patient registration form and submit it before your patient visit. Please be assured that you are submitting the form to a secure site. We will get your signature when you come in for your scheduled appointment.

In addition to completing the on-line form, please bring your insurance card with you to the check-in window at your scheduled appointment. In addition, if your insurance carrier requires a written referral from your family doctor, please be sure to bring it with you. Also please bring any appropriate x-rays, CT or MRI scans, lab results, or any other pertinent medical information that would be helpful to our physicians.

IF THE PATIENT IS UNDER THE AGE OF 18, HE OR SHE MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN.

Thank you for using our on-line registration. We look forward to meeting you.

Respectfully,

The Staff and Physicians of Piedmont Ear, Nose & Throat Associates, P.A.

• click here to read the HIPAA policy

• click here to register online