Please download and complete the following six (6) forms before your first office visit to the Ear Institute of Chicago.
(The forms are editable. You may type into the appropriate form fields on your computer (Mac or PC).
To download the PDF forms, you must have Adobe Acrobat Reader (on a PC) or Preview or Adobe Acrobat Reader (on a Mac) computer. If you do not have Adobe Acrobat Reader, you may download a FREE copy of Adobe Acrobat Reader here.
1. Patient Registration Form
2. Patient Health History Form
3. Consent for Treatment Form
4. Privacy Acknowledgement Form
5. Patient Communication Consent Form
6. Patient Portal Proxy Access Form