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Ear, Nose & Throat Specialties – New Patient forms

Authorized User/
Authorized Representative

Cancellation/No Show
Procedure Consent

Patient
Demographics

Permission to
Treat a Minor

Ear, Nose & Throat Specialties forms

Notice of Privacy Practices

Dizziness Questionnaire
(only if instructed)

Workers’ Compensation
(only if instructed)

Liability Information
(only if instructed)

Auditory Brainstem Response (ABR) Testing

Surgical Center forms

Endoscopic Sinus
Surgery Instructions

Tonsillectomy and
Adenoidectomy
Instructions

Advance Medical
Directive

Notice of Privacy Practices

Patient Rights and Responsibilities