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Douglas C. McCorkle, M.D., F.A.C.S.

Otolaryngology Head and Neck Surgery. Specializing in friendly care and professional treatment of the Ear, Nose and Throat.

Owings Mills Office: (410) 363-7172

Westminster Office: (410) 876-2525

2 meds

All patient information forms can be printed, completed and either faxed, mailed or brought in with them the day of their appointment. Please use only our main office fax number (410-363-7188) for forms.

 

Click one of the links below to download the forms you need in the format you desire.

Please complete the forms and fax or mail to our Owings Mills office.

 

NEW PATIENT REGISTRATION FORM
download and fill out HIPPA forms as well

 

word icon Click to download Word document

                or

pdf icon Click here to download a PDF document

 

HIPPA Forms - download and complete one of these forms as well.

word icon Click to download Word document

                or

pdf icon Click here to download a PDF document


 

NEW PATIENT QUESTIONAIRE - PEDIATRIC/ADOLESCENT
download and fill out HIPPA forms as well

 

word icon Click to download Word document

                or

pdf icon Click here to download a PDF document

 

HIPPA Forms - download and complete one of these forms as well.

word icon Click to download Word document

                or

pdf icon Click here to download a PDF document


 

NEW PATIENT QUESTIONAIRE - ADULT
download and fill out HIPPA forms as well

 

Click the link below to download the document you need in the format you desire.

word icon Click to download Word document

 

pdf icon Click here to download a PDF document

 

HIPPA Forms - download and complete one of these forms as well.

word icon Click to download Word document

                or

pdf icon Click here to download a PDF document


Insurance Accepted

Medicare

Bluechoice HMO

Bluechoice PPO

Bluechoice POS

Open Access

Cigna

JHHC

EHP

Aetna HMO

BCBS Blue Card PPO

First Health PPO

Great West PPO

Multiplan PPO

PHCS PPO

Aetna Choice PPO

UHC Choice Plus POS

UHC Options PPO

Humana ChoiceCare Network PPO

Coventry Health Care of DE HMO

Kaiser Permanente Mid-Atlantic

 

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