Complete Patient Online Packet
Welcome to Premier ENT, thank you for choosing our practice for your Ear, Nose and Throat health care needs. Our goal is to meet your individual needs and to provide quality medical care in a convenient, comfortable setting.
Our office is open five days a week, Monday through Friday 8:30am until 4:30pm. Should you need to contact us during regular hours, just dial (909)793-2500 and follow the prompts to speak with a member of our staff.
On this page you will find a number of online forms for you to read, complete, and sign.
- Patient Registration
- Medical History Form
- Notice of Privacy Policies and your Rights as a Patient
We ask that you arrive at our office 15 minutes prior to your scheduled appointment time.
Please bring with you to the appointment:
- Your insurance card(s)
- Your copay
- A photo ID
- All of the papers in this packet
- A current medication list
- Results from recent lab work or radiology studies (x-ray, CT scan, ultrasound, etc.)
We understand that you have many choices when it comes to finding a healthcare provider, and we are pleased you have chosen Premier ENT, Inc. We look forward to meeting you and providing you with high quality medical care.
Please complete ALL of the 5 steps on this page.
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Insurance Plans Available
All Major Carriers
Aetna/US Healthcare
Blue Cross
Blue Shield
CIGNA
Healthnet
Humana
Medicare
PHCS
HMO
Aetna/US Healthcare
Blue Cross
Blue Shield
CIGNA
Healthnet
Humana
Medicare
United Healthcare
Group Affiliates
Inland Health Org.
Physicians Health Network
Pinnacle
Prime Care
RYMG
Regal
SBMG
United Family Health Care
Other PPO Plans Accepted
AARP
Admar
Aetna - All
American Postal Workers Union
Affiliated Health Fund
Accountable
Benesight
Carpenters Health & Welfare
Cement Masons
CCN
Cigna
Coventry
EBA&M
First Health
GEHA
Great West
Health Net
IBEW
Laborer / Operating Engineers / AC H&W
Medicare
Megalife
Motion Picture Industry Health
Megalife
Motion Picture Industry Health
Mutual of Omaha
Pacificare
Pipe Trades Union (SCPT)
Physicians Health Network
The Plan Handlers
Principal Life
Religious Comprehensive Trust
Riverside County Foundation
(RCFMC)
Screen Actors Guild
SCAN
Secure Horizons
Sheet Metal Workers
Southwest Administrators
Southern California Drug Benefit Fund
State Farm
Tricare
Teamsters
United Food & Commercial Workers
(UFCW)
UHP
Unicare
Union Labor Life
Trust Your Health to an Expert
Useful Patient Information
PAYMENT INFORMATION
Co-payments and payment for services not covered by your insurance will be due at your visit. For your convenience, we accept cash, check or all major credit cards. We will also file your claims for all surgical procedures. Remaining balances and deductibles will be billed to you.
If you have questions regarding insurance and payments please contact us at (909) 793-2500
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