Prior to your initial visit to Midwest ENT, you will need to complete our selection of Patient Registration forms. By completing these forms before your appointment, we can have your paperwork ready when you arrive and decrease your waiting time to see your physician. Please complete and submit the forms below.

If applicable, please bring any related CAT scans, lab work, CT scans, or MRIs to your appointment, as well as your Primary and Secondary Insurance cards or information. We may need to keep a photocopy of this information on file. Thank you for your help in expediting this process!

If you prefer to print and complete our patient forms and bring them with you to your appointment, please click here to download the PDF. If the forms are not displaying properly on your device, please visit this New Patient Forms page to complete your forms through a secured link.


Phone: 812-473-2060
Toll Free: 877-888-4368
Fax: 812-473-0763
1020 Professional Blvd.
Evansville, IN 47714


Phone: 270-827-2312
Fax: 270-827-4440

1305 N. Elm St., Suite 110
Henderson, KY 42420


Phone: 812-886-3460
Fax: 812-886-4458

607 Dubois
Vincennes, IN 47586


Phone: 812-547-7011
Toll Free: 877-888-4368

8885 IN-237
Tell City, IN 47586

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