Patient Forms
Patient Demographics and Financial Policy Form
PHI HIPAA Form
Review of Systems Form
ENT Symptoms Form
NOTICE
It is your responsibility to check to see if Dr. Robert A. Ehrhard is in your insurance network before your appointment.
If your insurance card shows that you have
a PCP (Primary Care Provider) or
are assigned to a
PMP (Primary Medical Provider),
you must have a referral from the provider listed on your insurance card to be seen in our office unless you’re willing to pay cash at the time of service.
(Dr. Ehrhard does NOT accept HMO insurance)
