PATIENT RESOURCES

Patient Resources

Call Us Today at (320) 310-4848 to Schedule Your Appointment

Our clinic hours are Monday through Friday from 8:00 a.m. to 5:00 p.m.
Most insurance plans accepted

Insurance

We participate with most insurance carriers. Please check with your insurance carrier to find out if your plan requires you to obtain a referral/prior authorization before coming to the clinic. Bring your insurance card(s) with you.

All co-pays are due on the date of service. St. Cloud Ear, Nose and Throat Clinic bills your insurance carrier(s) for charges incurred during your visit(s) with us. Any balances left over after your insurance carrier(s) have processed your claim are your responsibility and will be due in full following the insurance payment.

Patients who do not have coverage under a health insurance plan are responsible for payment of the entire amount of their bill. Such balances must be paid upon receipt of your statement. A deposit of $50.00 per scheduled provider will be obtained at the time of a visit.

Credit Policy

We accept a variety of payment methods including:
  • Cash
  • Check
  • Money Order
  • Visa
  • Mastercard
  • Discover
We offer advice to help assist you in meeting your financial obligations. If you are unable to pay your bill in full, you have the following options:
  • Click here for financing solutions through Bremer Bank
  • Call our Billing Department at 320-252-0233, option 6, to assist you with other financial arrangements. A reasonable payment plan can be formally established through our office, but you must call us to set this up.
  • Apply for Medical Assistance in the county in which you live. To see if you are eligible, go online to www.mnsure.org or call 1-855-366-7876.
Download Our Billing Policy

Smoking

We are a smoke-free environment and do not allow smoking in our clinic or on clinic grounds.

Patient Forms

Authorization and Consent for Treatment/Financial Agreement
This form authorizes the clinic to release your information to designated parties and also includes acknowledgement of our privacy practices form, consent for treatment and financial policy.
Download Authorization and Consent for Treatment
Patient Health History Form
This form is generally provided upon check in for your appointment. You are welcome to fill it out in advance and bring it with you.
Download Patient History Form
Release of Medical Information Form
This form is for your use in releasing information from our clinic to the medical provider of your choice.
Download Medical Release Form
Minor Patient Consent Form
A parent or legal guardian must be present for a minor patient’s visit to the St. Cloud Ear, Nose and Throat Clinic. If the minor patient’s parent or guardian is unable to attend the visit, they may appoint a designated adult to accompany the patient to their visit. 

Please complete the form below to allow for a designated adult to accompany your child to their visit at the St. Cloud Ear, Nose and Throat Clinic. We will be unable to treat your child without written consent from you.
Download Minor Patient Consent Form
Privacy Practices
This form is intended as your information regarding our clinic's privacy practices.
Download Notice of Privacy Practices

What's Your Sinus IQ?

Don't suffer with sinusitis or allergy symptoms - lasting relief is within reach!

Take The Quiz
person suffering from sinus pain in Minnesota
Share by: