Patient Registration Forms

In order to expedite the patient registration process, please download the registration form below, print all four pages, fill it out and bring it/them with you on your first visit to our office. Thank you!

ENT and Allergy EMR History Form, Microsoft Word version

ENT and Allergy EMR History Form, PDF version

This file is in Adobe Acrobat PDF format. If you don’t have the viewer already installed on your computer, you can get a free copy of the latest Acrobat Reader here.

If you are unable to download the Adobe Acrobat Reader, please click on the appropriate link below to access a graphic version of the registration form, print it, fill it out and bring it/them with you on your first visit to our office. There are FOUR (4) pages that need to be printed, so please make sure that you print ALL FOUR pages...thank you!

ENT and Allergy EMR History Form, graphic version-Page One
ENT and Allergy EMR History Form, graphic version-Page Two
ENT and Allergy EMR History Form, graphic version-Page Three
ENT and Allergy EMR History Form, graphic version-Page Four

We have also added an Authorization for Release of Information form, posted in Microsoft Word format, and accessed by clicking here.