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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.) Please print two copies of the Patient Registration and Medical Forms

3.) Please fill out each of the forms completely and mail or fax both forms to the location you will be visiting:

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

5.) 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, Tell City and Princeton:
Evansville:
1020 Professional Blvd.
Evansville, IN 47714
Fax: 812-473-0763

4.) Bring the second completed copy of each of the new patient forms with you to your appointment.

5.) If applicable, bring any CAT scans, labs, CT scans, or MRIs that may relate to your appointment.

6.) 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!