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Appointments

Please use our email appointment service for scheduling NON-EMERGENCY appointments ONLY.
You will be called with an appointment time within 1 business day.
To schedule an EMERGENCY appointment, dial 713/796-2001.

Have you been seen at Texas Ear, Nose and Throat Consultants before?
	Yes
	No

At which office would you like to be seen?
	Medical Center (All Doctors)
	Sugar Land (Dr. Duncan, Dr. Edmonds)
	Cy-Fair/1960 (Dr. Albright)

With whom would you like to schedule this appointment?
	Newton Duncan, M.D. (pediatric ear, nose and throat)
	Joseph L. Edmonds, Jr., M.D. (pediatric ear, nose and throat)
	James T. Albright, M.D. (pediatric ear, nose and throat)
	Ronald J. Vilela, M.D. (pediatric ear, nose and throat)
	Tiffany P. Raynor , M.D. (pediatric ear, nose and throat)

Please briefly explain the medical problem for which we will be seeing you:
Last name:
First name:
Middle initial:
Date of birth:
Home street address:
City:
State:
Zip:
Home phone:
Business phone:
Pager / cell phone:
Email Address:
How would you like to be contacted?	Home Phone Business Phone Cell Phone Email

Requested Date:
Requested Time:
Insurance company:

Smith Tower Office
6550 Fannin Street
Suite 2001
Houston, Texas 77030
713-796-2001
713-796-2349 fax


	Texas ENT Centers of Excellence > ENT \| Face \| Hearing \| Pediatric \| Voice
	© 2003 Texas Pediatric Otolaryngology Center