Patient Forms
Download and print the appropriate forms to save you time at your office visit. Don't forget to bring the completed forms with you to your visit.
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Required Registration Forms
DOWNLOAD AND COMPLETE THESE FORMS PRIOR TO YOUR FIRST VISIT. ALL FORMS ARE IN ADOBE PDF. DOWNLOAD ADOBE READER FOR FREE.
New Patient Information Form
Disclosure of Beneficial Interest
Insurance and Self-Pay Payment Terms
Minor Consent for Treatment
Patient Consent to the Use and Disclosure of Health Information
Privacy Notice
Our Mission
It is the mission of ENTAA Care to provide high quality, cost effective, specialty medical care to the patients in our communities. We will be a comfort to our patients,
a resource to our referring physicians and a health care advocate for our communities. These ideals will be carried out with the utmost integrity.
Contact Us:
Due to excessive spam we can no longer respond by email. If you have a question please contact our office by phone: 410-760-8840.