Please print and complete the following forms:
- Adult Questionnaire OR Pediatric/Adolescent Questionnaire
- Patient Acknowledgment of Privacy Practices
- HIPAA Communication Form
- Financial Policy
- If your visit is related to dizziness, balance, or vertigo, please print this form.
- If your visit is related to snoring concerns, please print this form.
Need to Know
Please review the following form (no need to print):
Please arrive 10-15 minutes early and bring the following:
- Your insurance card
- 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.
For established patients returning for special testing:
If you've been seen at an outside facility which has records pertinent to your condition:
- Please complete this request form. You may send it to the office to handle the request or submit directly to the outside facility.
“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."