Patient Forms

We’d like to encourage you to take advantage of the NoMoreClipboard program to submit your information to our practice. Click on the icon at right to get the Premium Family Account at no charge (a $29.95 value).

If you choose not to use the NoMoreClipboard program you can download the forms below and fill them out manually.


Please complete and submit the New Patient History Form, Patient Information Form and Sleep Apnea Screening Form prior to your first appointment.

If you are a continuing patient and any of your information has changed, please complete the appropriate form and submit before your next appointment.

Patient
Registration
New Patient
History
Sleep Apnea
Screening
Disclosure
Authorization
Notice of Privacy
Practices
Click on any image above to access that form



ENT Associates of Southern Indiana   •  Bloomington  •  Bedford  •  Paoli  •  Linton