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Patient Info

Patient Forms

Pre-registration Forms

Please print each of the following forms and complete them prior to visiting the office. Bring the completed forms the day of your visit. This will save you and the Center time in processing your file.

This one file includes the Patient Registration Form, Patient Medical History Form, Financial Policy and Consent for Privacy Practices.

Center for ENT Patient Forms Center for ENT Patient Forms
Other information (optional)
Insurance Plan Participation Insurance Plan Participation
Notice of Privacy Practices Notice of Privacy Practices
For all Appointments & Inquiries (713) 795-5343
Meet Our Doctors
Sam C. Weber, MD, F.A.C.S. Sam C. Weber, MD, F.A.C.S.
Sam C. Weber, MD, F.A.C.S.
Ron L. Moses, MD, F.A.C.S. Ron L. Moses, MD, F.A.C.S.
Ron L. Moses, MD, F.A.C.S.
Richard T. Hung, MD, F.A.C.S. Richard T. Hung, MD, F.A.C.S.
Richard T. Hung, MD, F.A.C.S.
Eric S. Powitzky, MD, F.A.C.S. Eric S. Powitzky, MD, F.A.C.S.
Eric S. Powitzky, MD, F.A.C.S.
Brett M. Cordes, MD Brett M. Cordes, MD
Brett M. Cordes, MD
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