Name: Houston Sinus & Allergy
Address: 11811 FM 1960 Rd. W. Ste 165, Houston, TX, 77065-3828
Telephone: (832) 237-7777

Houston Sinus & Allergy is pleased to provide telehealth/virtual care appointments for your ENT needs with our otolaryngologist, Dr. Nguyen. Please fill out the form below to request a telehealth visit.

IMPORTANT: You are scheduling a Telehealth Appointment (virtual visit).
This service is for non-urgent appointment requests.
IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911.
If you have an urgent need or are experiencing post-operative concerns, please call the office at (832) 237-7777.

By entering your full name, email address, insurance information and phone number below, you are providing personal information that will be used by Houston Sinus & Allergy for the sole purpose of responding to your request. We will only use this information to contact you in order to schedule your appointment.

Telehealth Appointment Request

Consent*
- I acknowledge that I have read and agree with the above information and terms of use.
Patient Name*
Email*
Phone*
Gender
What is the primary reason for your visit?*
Please Note: We are unable to schedule surgeries from our website. To schedule surgery please contact the office directly.
Who are you making this appointment for?*
Are you a new patient?*
- Yes
- No
Have you had surgery with one of our physicians in the past month?*
- Yes
- No
Are you experiencing any of the following: Fever, cough, or nausea/vomiting?*
- Yes
- No
Date*
Date format: MM/DD/YYYY
Date Format: MM slash DD slash YYYY
What Time Of Day Would You Prefer?*
Who is your insurance carrier?*
BCBS, United Healthcare, Aetna, Medicare, etc.
Plan Type*
Please verify from your insurance card. ex: PPO, EOP, POS, HMO, etc.
Insurance subscriber number*
If we are not contracted with your insurance, or we are unable to confirm your coverage, we will contact you directly.
Group number*