Mark Aferzon, M.D.

ENT & Allergy

Patient Info/Forms
 
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 office hours

Monday

9:00 AM

-

1:00 PM

Tuesday

1:00 PM

-

6:00 PM

Wednesday

9:00 AM

-

1:00 PM

Thursday

1:00 PM

-

6:00 PM

Friday

9:00 AM

-

1:00 PM

Call 203-954-0019 to schedule an appointment.

If you need to cancel or reschedule an appointment, please make every effort to contact us within 24 hours.

 


 new patient forms

 

For your convenenience, new patient registration forms are available to be printed and completed prior to your appointment. Please bring the completed forms with you. The forms are in pdf format and require Adobe Acrobat Reader (click here for FREE Reader). Please download, print and complete each of the following forms:


 patient checklist

  • Bring pertinent CT, MRI and X-RAY film(s) and report(s).

  • Bring pertinent studies, labwork, doctor notes and operative reports.

  • Bring list of Medications (include name, dose and frequency).

  • If a referral is required by your insurance plan, please contact your primary care physician prior to your appointment, so that they may fax it to our office @ 203-954-0018.

  • All copays and deductibles are due at the time of service.

  • Bring your insurance card(s) and photo ID.

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Copyright 2006 Mark Aferzon, M.D. All rights reserved.
Last updated 07/28/12