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 Expedited Check-in Procedures

Thank you for choosing Drs. Gaul, Kelleher and Kelley for your medical care. The Physicians and Staff at Eastern Shore ENT & Allergy look forward to providing you with the highest quality care. To help expedite the check in process, we ask that you complete the enclosed forms. Please be certain to answer all questions, including the yes or no questions on the medical history, and sign both forms. You will need to bring the completed forms, a list of your current medications with the dosage, and your current insurance cards with you at the time of your appointment.

If your health insurance company requires a referral you must contact your Primary Care Physician to obtain the referral prior to arriving for your appointment. Health insurance companies requiring a referral will not authorize us to see you without this written referral.

For first time patients under the age of 18 a parent or legal guardian must accompany the patient to the first office visit. For follow up appointments after the first visit you may send written consent for someone other than parent or legal guardian to bring the patient to their appointments. Keep in mind we will be unable to see the patient without this information. We must have this on file for future visits.

We will make every effort to see our patients as close to their appointment time as possible. However, we are a surgical practice and are subject to emergency circumstances that are beyond our control. We ask you for your patience should any delays occur. Any missed appointments will be charged a $40.00 fee. Please notify us within 24 hours of cancelling.


Download Patient Registration Forms