Welcome to Austin Ear Nose & Throat's online pre-registration. For your convenience we offer two methods to pre-register. You can print a blank copy of the registration forms and fill them out before coming in for your appointment; or you can choose use our secure online registration. In either case we must first know which doctor or office you will be visiting in order to provide the correct forms.
Please note: if you would like to complete pre-registration for more than 1 patient, you will need to delete the cookies and temporary internet files from your browser after each pre-registration is complete.

To fill out this form you will need:

  • Policy, group, and claim phone numbers for applicable insurances
  • Full name of referring doctor and Primary Care physician
  • Knowledge of medical history

If you cannot complete a field that is marked as required, please enter N/A into the field for not available.


Begin online registration

OR

Load a previously saved registration
(For privacy reasons, you cannot load a previous registration unless you have saved it and set a password)