Ear Nose Throat Sleep Hearing Aids Lebanon PA

Patient Resources

New Patient Information

Thank you for making an appointment with Melnick Moffitt Mesaros ENT Associates!  In order to expedite the check-in process during your first visit, please review the information below and complete any necessary steps.

Secure Patient Portal

The patient portal will be down from 2am-4am every morning for system maintenance.

Click here, to learn more about how the portal works.

Appointments, prescription refills, lab results and much more...

Secure Patient Portal Access


Please complete and bring the following form with you to your appointment:

Patient Registration Form (Coming Soon ...)

Health Information

You can enter your health history and current symptoms directly into our electronic medical record via our secure online patient portal. If you do not know the login information for your patient portal account, please call us at 719-867-7800.

Secure Online Patient Portal (Coming Soon ...)

Consent & Financial Policies 

Please print out, complete, and bring the following form with you to your appointment:

Financial Agreement

HIPAA One® Certified SealHIPAA

Please review our Notice of Privacy.  We will ask you to sign an electronic “Acknowledgment” form when you arrive for your appointment.  Your signature will acknowledge that you have received or been given the opportunity to receive a copy of our Notice of Privacy Practices.

Notice of Privacy Practices

Insurance Card(s)

Please bring your current insurance card(s), primary and secondary (if applicable), with you.  We will scan your card(s) into our practice management system to ensure we have the correct information to file claims with you insurance company.

Accepted Insurance Companies

  • Aetna (Coming Soon...)
  • AARP
  • Advantra 
  • Amerihealth Caritas PA
  • Highmark Blue Shield
  • Capital Blue Cross
  • Cigna
  • Keystone Health Plan Central
  • ChampVa
  • Freedom Blue PPO
  • Gateway Health Plan
  • Gateway Medicare Assured
  • Geisinger
  • Humana Military
  • Medical Assistance
  • Medicare
  • Medicare Railroad
  • Primesource (PSHN)
  • Wellspan

Other insurances may be accepted depending upon their relationship to the above carriers. Please check with your insurance company to see if we are in network.


If your insurance plan requires a co-pay for a physician office visit, we will collect the applicable amount when you check-out.  Keep in mind, our physicians are specialists, and your insurance plan may, thus, require a higher co-pay than for a primary care physician office visit.


The following insurance companies require a referral to be seen by a specialist:  Aetna, TRICARE, and United.  Therefore, we will not be able to schedule your appointment until we receive the referral from the insurance company.  Please work with your primary care physician and insurance company to complete the referral process.

Payment Information

If your account has a balance for any services we have provided in the past, we will send you a statement.  We accept cash, check, and credit card, and you can make your payment via the return envelope with your statement.

You can also make a payment online.  If you have any problems making a payment, please contact our office.  Keep in mind, we will collect any account balance when you check-out during your next visit.

Make a Payment (Coming Soon ...)

Medical Records Request

To request copies of your medical record, please print out, complete, and fax the following form to (719) 867-7899:  

Authorization to Disclose Medical Records Form (Coming Soon ...)

Keep in mind, the current copy fees are as follows:

1-10 pages:  $14.00
11-40 pages:  $.50 per page
41+ pages:  $.33 per page

There are no copy fees if records are sent directly from our office to another healthcare provider.  If you have any questions regarding medical records requests, please call (717) 274-9775.  

Patient Satisfaction Survey

The physicians and staff of Melnick, Moffitt, and Mesaros ENT Associates are committed  to providing the best care and service to our patients.  To do so, we need  your help in assessing how successful we are in meeting your needs.

Please click on the applicable picture below and complete the short survey. Your response will be kept and confidential and anonymous.

Thank you for taking the time to share your feedback.

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