Patient Info

Patient Forms

New Patients
To expedite your office visit, please print out the New Patient Forms, (left click to view and fill out, right click + save as to download) fill them out and bring them to your first office visit.

***NOTE*** These forms can be filled out in your browser. In order to save your filled out form you must select ‘print’ in your browser, then select ‘destination’ and from there you can ‘save it as a pdf’ and you will save the complete form with all of the information you filled in. Selecting ‘save as’ will only save the blank PDF.

Information for Patients Undergoing Surgery
Surgery Instructions (left click to view, right click + save as to download)

General Info
HIPAA Statement (left click to view, right click + save as to download)

Insurance & Financing

Dearborn Ear, Nose & Throat accepts the following insurances:

  • BCBS of MI
  • Federal BCBS
  • BCN with referral from Primary Care Physician
  • BCN Advantage
  • Medicare
  • Medicare Plus Blue
  • Aetna
  • Cofinity
  • Railroad Medicare
  • HAP HMO – Open Delivery
  • HAP Senior Plus HMO – Open Delivery
  • HAP PPO
  • Cigna
  • Humana Medicare
  • United Healthcare
  • Alliance Health PPO
  • Priority Health PPO
  • Priority Health HMO
  • Health Plus PPO
  • Tricare
  • Humana
  • PPOM

Please be aware certain insurances have specific networks of providers, and patients can be penalized for using a provider out of their specific network. If you have any concerns contact our office to insure we are in your network.

We also are happy to see uninsured patients or patients who do not wish to use their health insurance. For current fees please contact our office at 313-582-8853.

Our office accepts cash, checks, and VISA and Mastercard for payments. We also participate with Care Credit, an independent financing company that allows for payment of services such as a hearing aid purchase over time.

Medical Information