Please print and complete the following forms:
- Privacy practices, financial policy, and HIPAA
- Adult Questionnaire OR Pediatric/Adolescent Questionnaire
If your visit is related to dizziness, balances, or vertigo:
If your visit is related to snoring concerns:
Please review the following form (no need to print):
Please arrive 10-15 minutes early and bring the following:
- A physical copy of your insurance card(s)
- A photo ID
- Referral (if required by your unsurance carrier)
- Co-pay (if required by your insurance carrier). We accept cash, check, and all major credit cards.
Click here for information about the No Surprises Act
For established patients returning for special testing:
- Allergy testing
- Instructions for VNG (balance/dizziness evaluation)
- Instructions/Information for evaluation at FYZICAL
If you've been seen at an outside facility which has records pertinent to your condition:
- To send your records to the Owings Mills office, please submit this form to the outside facility.
- To send your records to the Westminster office, please submit this form to the outside facility.
- To send your records to the Rosedale office, please submit this form to the outside facility.
- To send your records to the Columbia office, please submit this form to the outside facility.
To request a copy of your medical records to be released to another provider or yourself:
- Please complete this request form and return to our office.
“I received excellent care at Chesapeake ENT. Their prompt response and cheerful attitudes made for a wonderful experience. All of the audiologists were very helpful. Especially Dr. Laura Toll, her knowledge of hearing aids and the new technology offered made for an easy decision."
"Was very knowledgeable and helpful."
"Very courteous and on time."