New Patient Forms

To help make your first visit to our practice as smooth as possible, please read the information on this web page. You’ll find all the practical information you need, such as a map and directions to our offices. We also describe our first visit procedures. And, you can save some time by printing out and completing the new patient forms in advance of your appointment.

Mission Statement

Our practice is made up of Board Certified physicians specializing in Otolaryngology/ Head and Neck Surgery (otherwise known as Ear, Nose and Throat). Our mission is to provide the highest quality care available to each and every patient in our practice

What to expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.

Patient Forms

If this is your first visit to our office, you will be asked to fill out informational forms prior to being seen by the doctor.
If you would like to print these forms and fill them out prior to your visit, please print the first five forms listed below.
You may either bring the completed forms to our office the day of your appointment or fax them to the office where you are scheduled to be seen.

Please click on a form(s) below to print them.

Patient Information
Patient Information Health History
Office Financial Policy
Request for Confidential Communication
Consent for Release & Use of Confidential Info
Notice of Privacy Practices
Authorization of Confidential Health Info to ENT of IL
Authorization of Confidential Health Info from ENT of IL

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