Office Forms

New Patients:

Please download and complete the following three (3) forms (Registration Form, Health History Form, Consent to Treat) before your first office visit to the Ear Institute of Chicago. You may chose to download either the HTML or the PDF version. To download the PDF forms, you must have Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, you may download a FREE copy of Adobe Acrobat Reader here. adobe acrobat icon

Patient Health History Form (The pdf version is editable. You may type into the appropriate form fields on your computer (Mac or PC): HTML | PDF

VNG (video nystagmography) instruction sheet: HTML | PDF