St. Joseph's Ear, Nose & Throat Clinic

		Patient Forms
		Patient Registration
		Patient Health History
		Treatment & Payment Consent Form
		Release of Record Authorization
		Notice of Privacy Practices

		Pre-Operative Instructions
		Post-Operative Instructions
		Patient Resources
		Allergy

Patient Information Update & History Forms

Please complete the Patient Rregistration Form before coming in for your appointment. If any patient information has changed since your last visit (i.e. insurance carrier, address, etc.) please also complete a new Patient Registration Form as well.

Patient Registration
Patient Health History
Treatment & Payment Consent Form
Release of Record Authorization
Notice of Privacy Practices

These forms are in Adobe Acrobat format. If you do not have Adobe Acrobat Reader on your computer, click on the icon below to download it for free.

St. Joseph's Ear, Nose & Throat Clinic • Thomas R. deTar, MD • M. Erik Gilbert, MD