(845) 727-1340 sue@rocklandent.com

2 Strawtown Rd #6
West Nyack, NY 10994

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Monday & Tuesday
9:00 - 2:30
Wednesday 10:30 - 7:30
Thursday 9:00 - 4:00
Friday 9:00 - 12:00

Call Us Today!

(845) 727-1340

Clarksville Court, 2 Strawtown Road

West Nyack, New York 10994

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Mon Tues Thur 9.00 - 4.00

Wed 10.30 - 6.30
Friday 9.00 - 12.00

Call Us Today!

(845) 727-1340

Rockland ENT Patient Forms

Please download the Rockland ENT Patient Form and fill out (all except signature) using your computer keyboard or mobile device. (You can open the downloaded forms in a web browser or Adobe Acrobat Reader.) You can then save the PDF with your information and either

Print it out and Fax to our office at (845) 727-1349;
or attach it to an email message and send to sue@rocklandent.com.

 

NOTE: You must sign the HIPAA Privacy Notice (page 1 of the combined forms), which you can do on your first visit to our office.
Please remember to bring to your first appointment:

Active Insurance Card
A photo ID
An active referral, if needed
X-rays, lab reports or other information that will make your visit more productive.

 

Download forms
You can download all the necessary documents in one PDF (recommended)

Combined patient forms

or you can download individual forms using the following links:

HIPAA Privacy Notice
History Present Illness
Medication Record
Patient Health Information
Patient Information
Sino-Nasal Outcome Test

 


NOTE: See also Allergy Testing.

 

 

Please download the Rockland ENT Patient Form and fill out (all except signature) using your computer keyboard or mobile device. (You can open the downloaded forms in a web browser or Adobe Acrobat Reader.) You can then save the PDF with your information and either

Print it out and Fax to our office at (845) 727-1349;
or attach it to an email message and send to sue@rocklandent.com.

NOTE: You must sign the HIPAA Privacy Notice (page 1 of the combined forms), which you can do on your first visit to our office.
Please remember to bring to your first appointment:

Active Insurance Card
A photo ID
An active referral, if needed
X-rays, lab reports or other information that will make your visit more productive.

Download forms
You can download all the necessary documents in one PDF (recommended)

Combined patient forms


or you can download individual forms using the following links:

HIPAA Privacy Notice
History Present Illness
Medication Record
Patient Health Information
Patient Information
Sino-Nasal Outcome Test


NOTE: See also Allergy Testing.

 

I brought my 8-year-old son to Dr. Berson because he was suffering with frequent painful tonsil infections and a terrible snoring problem. After having a sleep study it was determined that he had sleep apnea. Dr. Berson performed a successful tonsillectomy and ade­noidec­to­my. Our family is thrilled with his prog­ress since the surgery: he is no longer snoring and has more energy during the day. Father of AG

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