Please download and complete the following form before your first office visit to the Ear Institute of Chicago.
(The form is editable. You may type into the appropriate form fields on your computer (Mac or PC).
To download the PDF form, 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.

Patient Health History Form