Below are some of our important forms. For new patients, the first three forms are very important. For your convenience and to expedite the registration process on the day of your appointment, our New Patient Registration & History Form may be completed in your web browser and sent to us securely on-line. New patients will review and sign the Consent for Treatment, Financial Policies form and the Notice of Privacy Practices Acknowledgement forms at the time of their appointments. Again, to expedite the registration process at the time of your appointment you may print these forms, review them and be prepared to sign them during the registration process. Our Notice of Privacy Practices is available here for you to review prior to your appointment.
- New Patient Registration & History Form
- Consent for Treatment, Financial Policies, Notice of Privacy Practices Acknowledgement
- Notice of Privacy Practices
- HIPAA Privacy Consent
- Dizziness/Vertigo Pre-Visit Evaluation Form
This form pertains to new patients experiencing dizziness/vertigo issues.
- Pediatric Preoperative History & Physical Examination Form
This form is for pediatric patients scheduled for surgery.
- Sino-Nasal Outcome Test (SNOT 20 Test)
This test is intended to define your symptoms and provide valuable information for your doctor.
- Skin Care Questionnaire
This form is for new patients of Medical Skin Solutions.
Allergy Clinical Forms
- Allergy Patient History
This form is for new Allergy Services patients.
- Allergy Testing Instructions
This form is for patients scheduled for Allergy testing.
- Allergy Shot Consent
This form is for patients who are prescribed allergy shots.
- Allergy Drops (SLIT) Consent
This form is for patients who are prescribed allergy drops.
- Beta Blocker Treatment Consent
This form is for patients who are prescribed allergy shots and currently on a beta blocker medication.
- Off-Site Allergy Shot Consent
This form is for patients prescribed allergy shots who wish to have them administered at another physician's office.