Patient Forms

Prior to your visit:

  • Request copies of medical records from your primary care doctor(s) or other specialists related to your ear, nose and throat problems including medications you have been treated with.
  • Request a copy of head & neck area X-rays/MRIs or CT scans unless performed at Concord Hospital (we need actual films or CD , not just paper report).
  • Request full copy of sleep study report and C-PAP records (if applicable)

What you should bring to your appointment:

  • Health Insurance Card
  • List of All Medications you are currently taking
  • Completed patient registration forms (download below)

Required Registration Forms

Will someone other than the legal parent or guardian be accompanying a minor child to the appointment?  If yes, please consider completing this consent for treatment:

Authorization to Consent to Treatment of Minor Child

Symptom-specific Questionnaires

Complete relevant questionnaires.  These self-assessment will help our providers to understand your symptoms more fully.

Treatment Forms

Nosebleed Treatment and Management Temporomandibular Joint Syndrome (TMJ)
Gargle/Nasal Spray Instructions Laryngopharyngeal Reflux

Post Operative Surgical Instructions

Adenoidectomy Ear Sugery
Office Excision of Lesions or Growths Endoscopic Sinus Surgery
Tonsillectomy and Adenoidectomy Parotidectomy
Ventilation Tube Insertion Septoplasty and/or Turbinectomy

Other Forms

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