Ear, Nose and Throat Specialists of Middletown
Forms

New Patients will need to fill out two forms.  The first covers general information and consent for treatment. The second form is a health history form.  Both forms should be brought to the office for the first visit. After checking in, another form is signed for HIPAA  authorization of treatment.

Demographics Form

Health History Forms

HIPAA Privacy statement

You will need Adobe Reader to display and complete the forms. Go to Adobe for the download.