Kim Richard Jones, M.D., Ph.D.
Adult and Pediatric Otolaryngology
Kathy Yu, M.D., M.P.H.
Adult and Pediatric Otolaryngology
Kristie McCulloch, M.A./CCC-A
Carolina ENT Associates 55 Vilcom Center Drive, Suite 140
Chapel Hill, NC 27514
phone: 919.942.7278
fax: 919.942.9029
Dr Jones Dr Yu Mrs. McCulloch Humanitarian Work Appointments Hearing Services
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Welcome to the Appointments Section

 

This portion of the website is intended for patients new to Carolina ENT, and contains all of the forms that you need to pre-register. Please download the forms, fill them out, and bring them with you to your first appointment. In addition, if you have been referred by another physician, or have had previous treatment for your ENT problem, please bring all pertinent doctor’s notes, x-rays, and lab studies. Don’t assume your doctor has sent these!! In addition, if your insurance plan requires a referral from your primary doctor, please check to make sure we have received this document prior to your first visit. If you have any questions about medical records or the necessity for a referral, please call and we will be happy to assist you. If you have any questions about what records are necessary or if your old records have been sent, please call our office before your visit.

 

 
If you are 18 or older, please click on the desired file format on the right to download all necessary forms. Print the forms by clicking the Print button on your computer, fill them out, and bring the completed forms to your first appointment.   132kb   36kb
If you are 17 or younger, or registering for your child, please click on the desired file format to the right. Print the forms by clicking the Print button on your computer, fill them out, and bring the completed forms to your first appointment.   132kb   32kb
Please click on the desired file format to the right if you would like to download our Notice of Privacy form.   96kb   40kb
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