ENT

Office: (361) 694-5778
Fax: (361) 654-0317

Fax information required by referring physician:

• DCH patient referral form (script signed by PCP)
• Insurance/Medicaid card (front and back)
• Physician’s notes
• ABR results, hearing test results, Sleep study results, Labs, X-Ray pertaining to the diagnosis (if available)
• Insurance Information, Demographics showing at least one of the parents full name & date of birth

Patient must bring to appointment:

• Patient must be accompanied by parent/guardian (with ID) who knows the history
• Guardianship paperwork/letter of medical consent (If patient is under care/custody of someone other than parent)
• Insurance/Medicaid card