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Patient Forms

Please print out and complete the Patient Health History and the Patient Registration Form before coming in for your first appointment.  
(Note: These forms must be updated yearly.  Filling them out in advance may lessen your waiting time.) 

We have developed questionnaires that pertain to ear, nose & throat disorders and diseases.  If either of the following surveys pertains to your symptoms, please complete the survey before your appointment.

Please bring all completed forms with you to your office visit.  You may also fax your forms to our office at (859)572-3044.  (Please bring the originals with you.)
Mark your appointment date and time at the top of the Registration Form.

      
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