Steven Peskind, MD
Ear, Nose, Throat and Allergy Specialist
Welcome to our practice. To make your first visit as efficient as possible, we ask that you take a minute to read this page.
New patient forms and documents
Please click on the appropriate New Patient Form link below, print the Patient Registration forms and Health History Questionnaire, fill them out and bring them with you to your appointment. It will save time at your first appointment if you fax the forms to 972-964-7209, or bring them with you.
Bring these forms along with your insurance card and a photo I.D. to your scheduled appointment. Completing this information is necessary in order to bill your insurance. Please call us at 972-596-2552 if you are unable to provide this information.
HEALTH HISTORY FORM ADULT
HEALTH HISTORY FORM CHILD
Patient Registration Form
Optimizing your appointment experience
Click here for a Patient Release of Information form that you may use.
- Complete the new patient registration form, the appropriate new patient
adult or child history form and the HIPAA privacy notice form. Fax all
forms to 972-964-7209 before the scheduled appointment. Please remember
to bring all forms with you.
- Any records you wish Dr. Peskind to review as part of your visit should be obtained by you before your visit. You will need to complete a release of information form and then fax or send it to the physician/hospital whose records would help in your evaluation. Click below for a Patient Release of Information form that you may use.
- Any X-rays, CT Scans, or MRIs and reports you wish Dr. Peskind to review as part of your visit should also be obtained by you before your visit. To facilitate obtaining any X-rays, contact the facility where you had the X-ray performed and ask them for both a copy of the films or CD-Rom, along with their report. You may need to complete a release of information form and then fax or send it to the hospital or imaging facility. It is very rare that a facility will directly send us your X-rays so you may need to pick them up and bring them with you to your appointment.
We ask that you arrive at our office 15 minutes prior to your appointment time.
Insurance, deductibles, co-pays and co-insurance
We accept most major forms of health insurance. Be sure to bring your insurance card and a photo I.D. to your scheduled appointment. If you would like to verify that we accept your insurance, please call us at 972-596-2552 prior to your appointment.
You will be responsible for any co-pay, deductibles, or co-insurance due at the time of service.
If you have HMO coverage, you must obtain a referral in order to be seen. It is your responsibility to ensure your referral is current and active prior to your appointment. Please call and confirm this information with our office at 972-596-2552.