Welcome as new patient to Crystal Community ENT. Dr. Grillo and his
staff always strive to make your visit to our office a pleasant and efficient
experience. Please help us by filling out the forms below prior to your first
visit. Please allot as much thought to your answers as possible by filling in
the basic information needed at your home instead of in the office waiting room.
Please take a moment now to click on the links below, print them out, fill in
the information as required and bring the forms with you on your visit.
Please click on the links below and review this information. If you
wish, you may print any of these documents out for your personal records.
New Patient Forms:
Patient History 1
Medication List (copies of list will not be accepted)
Our Office Policies
Receipt of Notice of Privacy Practices
Established Patient Updates:
Patient History Update
Your Rights to Privacy
Insurance Policy's (Insurance Information)
Patient's Rights & Responsibilities
Medical Records Release
Please only print and fill out one questionnaire per visit. Even though you may
feel you have all of the issues listed below. Please understand that we have not
allotted enough time in our schedule to go over all of these questionnaires. If
Dr. Grillo during his exam feels one of these additional forms are needed he
will go over it with you at the time of your visit.
Allergy History Questionnaire
Sinus Symptoms Questionnaire
We want our patients to be able to comfortably afford our care. We will gladly discuss our
financial policies with you before beginning your treatment. We accept credit cards for payment of services. If you carry insurance, a member of our staff will be glad to explain your benefits.
We accept VISA, MasterCard, AMEX, and Discover for credit payments.