Patient Forms

We ask our patients to complete these forms before their first appointment. Please click on the link below, print the forms and fill them out before coming for your first visit. Click on the links below to download form.

• Demographics
• Medical Survey

Other Forms

• Authorization for release of medical records
• VNG and VAT instructions

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.

Allergy

Evaluation and treatment of allergies including skin testing and desensitization injection.

Cosmetic Procedures

• BOTOX®
• Dermal Fillers (Restylane® and Juvéderm™)

Facial Plastic and Reconstructive Surgery

• Blepharoplasty (eyelid rejuvenation)
• Chin Implants
• Facial Rejuvenation (Face, Brow and Neck Lift)
• Otoplasty
• Reconstructive Surgery
• Rhinoplasty (including difficult revision surgeries)

Head & Neck Surgery

Medical and surgical treatments of benign and malignant tumors of the head and neck, including:

• Ear, nose, and throat
• Neck
• Larynx
• Salivary Glands
• Skin and Scalp
• Thyroid & Parathyroid
• Tongue and Oral Cavity

Nasal and Sinus Disease

• Medical and surgical treatment of sinus diseases
• Nasal obstruction
• Sinus disease - endoscopic sinus surgery

Otology

• Audiologic evaluation of patients of all ages (hearing test)
• Evaluation and Treatment of Balance Disorders
• Evaluation and Treatment of Hearing loss
• Medical and Surgical Management of acute and chronic disease
• Evaluation and Treatment of Tinnitus

Pediatric ENT

• Allergy
• Ear infections, for which myringotomy, and ear tube placement are options
• Infections of the Tonsils and Adenoids
• Sinus Disease
• Sleep Apnea

Snoring and Sleep Disorders

• Medical Therapy
• Somnoplasty™
• Pillar Procedures

Thyroid & Parathyroid

• Evaluation and surgical treatment of thyroid tumors
• Evaluation and surgical treatment of goiters
• Evaluation and surgical treatment of hyperparathyroidism
• Minimally invasive surgical options techniques

Voice & Swallowing

• Evaluation and treatment of voice disorders
• Evaluation and treatment of vocal cord weakness
• Evaluation and treatment of swallowing disorders using the latest non-invasive diagnostic approaches (www.feesst.com)
• Evaluation and treatment of benign and malignant vocal cord and laryngeal lesions
• Minimally invasive surgery of vocal cord