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Patient Forms


Prior to your initial visit to Midwest ENT you will need to fill out both the Patient Registration form and Patient Health form.  By completing these forms before your appointment, we can have your paperwork ready when you arrive and decrease your waiting time to see your physician.  Please follow the following steps, we look forward to seeing you:

1.) Click here to download the patient form Patient Registration and Medical Forms

2.) Bring a completed copy of each patient form with you to your appointment.

3.) If applicable, please bring any related CAT scans, lab work, CT scans, MRI's to your appointment.

Vincennes: 
607 Dubois 
Vincennes, In 47591
Fax: 812-886-4458

Henderson:
800 North Elm Street
Henderson, KY 42420
Fax: 270-827-4440

All Other Locations including- Evansville and Tell City:
Evansville:
1020 Professional Blvd.
Evansville, IN 47714
Fax: 812-473-0763

4.) Finally, don't forget to bring your Primary and Secondary Insurance Card/Information! We may need to keep a photocopy of this on file.

Thank you for your help in expediting this process!