Our ENT services cost 40% percent less than hospital-based care.

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Patient Forms at Southern ENT Associates in Louisiana

Expedite your visit at Southern ENT Associates by having your forms ready. Submit your new online patient registration form before you arrive. for more information. Contact us or schedule an appointment online!

Patient Forms

New Patient Consult Request Form

Release of Information

Patient - APPatient Application Instructions

Health Information Disclosure Form

Disclosure of Financial Interests

Patient - Patient Portal Instructions

Requesting Records Online 

As members of the Elevate ENT Partners network, we now offer an online records request tool that verifies your identity by asking for a photo of your driver's license, which can be taken via webcam or smartphone. There is no additional charge to use this service.

Click the button below, select "I'm ready, let's get started", then select your State to get started. 
Please note: Chrome, Safari and Firefox are the recommended browsers for this application 

CLICK HERE TO REQUEST YOUR RECORDS ONLINE

For Medical Professionals

Records request tool

Our paperless request process does not require a login but uses email verification for enhanced security.  No faxing, scanning or printing will save you time.

Note: Please use a recent version of Chrome, Firefox or Safari

RECORDS REQUEST FOR PROVIDERS

With 6 convenient locations in Southern Louisiana, we make accessing the treatment you need easy.

Find Your ENT Request Appointment
Accessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at (985) 200-8006.