New Patient Forms

Before you first visit, please read, fill out, and e-sign the following documents. This helps speed up the insurance verification and registration process, making your wait time a lot shorter.

Notice of Privacy Practices Acknowledgement

I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have a certain right to privacy regarding my protected health information. I understand that the information can and will be used to:

  • Conduct, plan and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
  • Obtain payment from third-party payers.
  • Conduct normal healthcare operations, such as quality assessment and physician certifications.

I have reviewed, read the office's Notice of Privacy Practices, posted in the lobby. I understand your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I understand that this organization has the right to change its Notice of Privacy Practice from time to time and that I may contact this organization at any time to obtain a current copy of the Notice of Privacy Practices.

I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or healthcare operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.

Patient Consent for Disclosure

Authorized persons that can obtain my personal health information:

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Medical Questionnaires

Sleep apnea and rhinosinusitis are two conditions that many Americans suffer from and often, may not even realize it. When left untreated, these conditions can lead to other serious physical and mental health issues. If you think you may be suffering from sleep apnea or rhinosinusitis, fill out one or more of the questionnaires below, and Dr. Matorin and his staff will go over the results with you at your appointment. From there, they will work with you to find a customized treatment plan suited for your needs.

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