Making an appointment is as simple as picking up the phone and calling our office, or by submitting your request below. You can also reach our scheduling department by calling (651) 641-6134.

Please arrive to your appointment prepared with a list of medications you are taking, if any. You will also be asked to provide a medical history so we can best accommodate your needs. Any patient arriving under 18 years of age must be accompanied by a parent or legal guardian.

We accept most insurance carriers and our services are available to all who seek them. You may become our patient either by making the appointment yourself or through a physician referral. If your insurance plan requires a referral to see a specialist, please contact your primary care physician to verify that a referral has been issued to us for your visit.

We strive to keep waiting times to a minimum, but please realize that delays can occur due to emergencies and unforeseen patient needs.

We understand that emergencies and special needs can occur, and we will do our very best to accommodate your specific needs. Should you need to cancel an appointment, please provide as much notice as possible in order for us to enable another patient to see the doctor. We request that patients provide at least 24-hours notice for cancellation of their appointment. Patients who do not provide 24-hour advanced notice of cancellation will be subject to our cancellation policy.

Request Appointment

REQUEST FOR APPOINTMENT

All fields are required

First Legal Name:
Last Legal Name:
Date of Birth:
Street Address, City, State & Zip:
Home Telephone:
Business Telephone:
Cell Telephone:
Our Scheduling Department will contact you via telephone to collect additional information and confirm your appointment with our practice.
Email Address:

Best contact method:
Health Insurance:

Reason for appointment (please include symptoms, past surgeries or medically diagnosed conditions):
What type of specialist would you like to see?

Please choose your preferred provider:

Business hours are 8 am – 5 pm, Monday – Friday with five convenient clinic locations. If you have a date, time and clinic preference for the appointment, please indicate below:

Weekday:
Time:
Location:

I authorize Midwest Ear, Nose & Throat Specialists and its associated divisions to reach out to me regarding my request for an appointment. I understand this form is only a request for an appointment and that I must receive correspondence from the clinic confirming the details that an appointment has been scheduled.

Please call our scheduling department at (651) 641-6134 with questions.