About Us | Patient Info |  Adult's Ear ClinicChildren's Ear Clinic
YOUR FIRST VISIT & INFORMATION FORMS

Welcome to my practice.  I appreciate the opportunity to provide you and your family's ear care.  My staff is made up of well-qualified professionals who work together as a team to bring you the highest quality treatment in a warm, caring setting.

Your initial visit will be spent obtaining as much information as possible: personal, medical history, insurance information, etc.  Listed below are a few steps to ensure your visit is informative and comfortable.

  • Download and complete the following forms.and bring them with you to your appointment. Please be sure to arrive 15 minutes before your appointment time.  This will allow us time to prepare your chart before your scheduled appointment.
  • You are responsible for obtaining an authorization for each visit to our office from your primary care physician, if your insurance requires one.  If we have not received a valid authorization, you will be required to pay in full at the time of your appointment.   Please be aware of the number of visits authorized and the expiration date of each authorization. You may call our office before your appointment to make sure we have received the authorization.
  • Bring all current medication with you, including those you have used to treat the condition for which you are seeing me.
  • Bring your insurance cards.  We will file your insurance claims. We must have a copy of your insurance card in order to file your claim.
  • By law we are required to collect your co-pay and co-insurances.  Please be prepared to pay these at your appointment.
  • If for any reason you cannot keep this appointment, please call us as far in advance as possible.
  • If you schedule an appointment and fail to cancel or reschedule within 24 hours or fail to keep it, there will be a $25 charge.
   Please obtain directions to our office from the "Map/Direction" portion of this web site.

Please feel free to contact us at (405) 751-7682 if you have further questions. My staff and I are looking forward to seeing you.

Sincerely,
Jack E. Metcalf, M.D.
 
 

The links below contain all the documents needed by Dr. Metcalf for your first vist. For your convience and to save you time on your first vist, you can download them and fill them out at your house. Then just bring them to the office for your first vist.

Adults Information Forms
Childrens Information Forms