Patient Forms

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Ear, Nose & Throat Specialties – New Patient forms
ENT_Authorized_User ENT_Cancellation_Policy ENT_Minor_Treatment
Authorized User/
Authorized Representative
Cancellation/No Show
Procedure Consent
Permission to
Treat a Minor
Ear, Nose & Throat Specialties forms
ENT_Privacy_Information ENT_Dizziness_Questionnaire ENT_Workers_Compensation ENT_Liability_Information
Notice of Privacy Practices Dizziness Questionnaire
(only if instructed)
Workers’ Compensation
(only if instructed)
Liability Information
(only if instructed)


Auditory Brainstem Response (ABR) Testing

Physicians’ Surgical Center forms
PSC_Sinus_Surgery_Post-op PSC_Tonsillectomy_Post-op PSC_Advance_Directive PSC_Notice_of_Privacy_Practices
Endoscopic Sinus
Surgery Instructions
Tonsillectomy and
Advance Medical
Notice of Privacy Practices
Patient Rights and Responsibilities