Lake Area Ear, Nose and Throat

New Patient Forms

All New Patient Forms

 

All new patient forms that need to be completed by patient or guardian compiled together in one file for convenient printing.

Notice of Privacy Practices

 

Printed copy of the office privacy policies for the patient’s personal records.

 

New patient forms can also be printed individually by clicking on the title below:

Registration Form

Health History Questionnaire

Consent to Treatment

Acknowledgment of Privacy Practices

Financial Liability Form

 

 

The forms are in  Portable Document Format (PDF) and can be viewed in  Adobe Reader.  You can download the software for free from the  Adobe website.