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Please remember to bring a photo ID to your appointment. We ask for a copy of your photo ID to help protect you against medical identity theft.

New Patient Forms:
  • Adult Patient Forms
    Required for adult patients.  Please complete and bring to your appointment.  

  • Pediatric Patient Forms
    Required for pediatric patients.  Please complete and bring to your appointment.

  • Notice of Privacy Practices
    Please review

  • Trouble opening forms?
    Click  HERE to download a copy of  Abobe Reader.  A new window will open taking you to Adobe's site.
     
    You can also click on the link below to download a MS Word document containing some tips from Adobe on opening PDF files.  

Out of Network Patient Forms:
  • Out of Network Waiver
    Required for Out of Network Patients

Established Patient Forms:
  • Medication Form
    Required for all patients - Please print, complete and bring to your appointment

  • Allergy Form
    Required for all patients - Please print, complete and bring to your appointment

  • Diagnostic Procedure Authorization
     Required for all patients - Please print, complete and bring to your appointment

  • Appointment Cancellation/ No-Show Policy
    Required for all patients - Please print, complete and bring to your appointment

  • Minor Waiver
    Required when somone other than a legal guardian is bringing a minor (younger than 18) years old  to an appointment.

Miscellaneous Forms:
  • Protected Health Information Form

  • VNG Instructions - 974 Bethel Road
    Please review this form if you are having a VNG performed at our 974 Bethel Road office.

  • ENG Instructions - Clime Road
    Please review this form if you are having an ENG performed at our Clime Road office.

  • Voice Center Intake Form
    Please complete this form if you are obtaining voice services.

The Facial Cosmetic Center Forms:
  • The Facial Cosmetic Center Questionnaire
    Our online interactive facial center questionnaire
 
JUL
29
Hearing Loss and Dementia

MAY
20
Who Should Get Ear Tubes?
 
     
 
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Ohio ENT
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