Patient Forms

Please review and complete the following five documents. Bring all five completed documents along with a valid photo id and your insurance card with you to your appointment. We look forward to meeting you soon.

Patient Registration Form
Patient Health History
Communication Authorization
Notice Regarding Diagnostic Testing
Notice of Privacy Practice (HIPAA)

Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Ear Nose and Throat Doctor Dr. John L. Fewins MD, serving Fort Worth, Grapevine, Southlake,
Colleyville, Alliance TX, Burleson, Weatherford, Granbury , Mansfield TX, Springtown and the surrounding area.

Fort Worth ENT

Fort Worth Office | 800 8th Avenue | Suite 626 | Fort Worth, TX 76104 | 817-335-0368
www.fortworthent.com

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