Patient Appointment (Patient Request)

To schedule, reschedule, or cancel and appointment with CornerStone Ear, Nose & Throat, please complete the information below and click submit. We will contact you to address your request.

Medicaid patients, please note: A referral from your primary care provider (PCP) is required to make an appointment. If you do not have a current referral on file, please stop here and call your PCP who will need to contact us to request an appointment or update your referral. New Medicaid appointments cannot be made without a PCP referral.

Once you complete and submit this form someone will contact you to schedule your appointment.

Please note that some of the fields of this form are required (*). Please complete the required fields before submitting.

Patient Info * What's your patient status? * What would you like to do? Which office would you like to visit? * Patient First Name Patient Middle Name or Initial * Patient Last Name

Date of Birth

* Month * Day * Year Social Security Number Parent or Guardian Name (if applicable) Primary Care Physician

Insurance Info Insurance Company Insurance ID#

Contact Info Contact Email * Contact Telephone Preferred Contact Method

Comments

Please describe your symptom or condition.

Healthcare Facilities and Privileges

All of the physicians at Cornerstone Ear, Nose & Throat are Board Certified in Otolaryngology and maintain medical, surgical and/or admitting staff privileges at the following Carolinas Healthcare System, Presbyterian/Novant, and independently owned facilities:

CMC Union, Monroe, NC

CMC Pineville, Pineville, NC

Matthews Presbyterian Hospital, Matthews, NC

Union West Ambulatory Surgical Center, Indian Trail, NC

The Surgery Center at Edgewater, Indian Land, SC

Presbyterian Surgery Center Ballantyne, Presbyterian Medical Plaza, Charlotte, NC

Presbyterian Surgery Center Monroe, Presbyterian Medical Plaza, Monroe, NC.

Arboretum

Monroe

Union County

Patient Appointment (Patient Request)

Questionaires

Privacy

Pre and Post-Operative Instructions

Healthcare Facilities and Privileges