Specialty: Audiology Clinics / Affiliations: Ear Nose & Throat 777 Hospital WaySouth Medical Office Building, Suite G15Pocatello, ID 83201Phone: 208-239-1960Fax: 208-478-0076Office Hours: Mon-Thurs 8-5, Fri 8-12 Overview Request an Appointment Submitted by ahs-admin on Fri, 12/29/2017 - 13:36 You must have JavaScript enabled to use this form. Alisa Vineyard, AuD, C-AAA, F-AAA First Name * Last Name * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Phone Number * Email * Date of Birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year Gender * - Select -MaleFemale Provider - Select - Have you been seen by a Portneuf Medical Group provider in the last three years? * - Select -YesNo Service Requested * - Select -Internal MedicineWound CareEar, Nose & Throat (ENT)SurgeryUrologyLung & Sleep DisordersCardiologyGastroenterologyOccupational MedicineInternational TravelNeurosurgeryInfectious DiseaseBariatricsPre Anesthesia Testing (PAT)HematologyMedical OncologyNeuroscience and RehabilitationInpatient PsychiatryHospitalistsPrimary CareVascular ServicesHeart & Lung SurgeonsOrthopedicsHeart FailureUrgent CareRheumatology Appointment Date Requested * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202420252026 Year Message|Additional Comments Leave this field blank Submit
Ear Nose & Throat 777 Hospital WaySouth Medical Office Building, Suite G15Pocatello, ID 83201Phone: 208-239-1960Fax: 208-478-0076Office Hours: Mon-Thurs 8-5, Fri 8-12
Request an Appointment Submitted by ahs-admin on Fri, 12/29/2017 - 13:36 You must have JavaScript enabled to use this form. Alisa Vineyard, AuD, C-AAA, F-AAA First Name * Last Name * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Phone Number * Email * Date of Birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year Gender * - Select -MaleFemale Provider - Select - Have you been seen by a Portneuf Medical Group provider in the last three years? * - Select -YesNo Service Requested * - Select -Internal MedicineWound CareEar, Nose & Throat (ENT)SurgeryUrologyLung & Sleep DisordersCardiologyGastroenterologyOccupational MedicineInternational TravelNeurosurgeryInfectious DiseaseBariatricsPre Anesthesia Testing (PAT)HematologyMedical OncologyNeuroscience and RehabilitationInpatient PsychiatryHospitalistsPrimary CareVascular ServicesHeart & Lung SurgeonsOrthopedicsHeart FailureUrgent CareRheumatology Appointment Date Requested * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year202420252026 Year Message|Additional Comments Leave this field blank Submit
