NIDCD

Welcome To Our Practice

Privacy Practices Notice

Patients' Rights and Responsibilities

In order to make your first visit with us go as smoothly as possible, we ask that you complete the following information sheets ahead of time:

Patient Information Sheet

Patient Medical History Sheet

Pediatric Medical History Sheet

Financial Policy

The following should be completed or read if they pertain to your visit:

Snoring and Sleep Apnea Questionnaire

Dizziness Questionnaire

After your visit, please complete this survey to help us continue improving our patient service:

Patient Satisfaction Survey

If you would like to obtain a copy of your medical records, please complete this form and send it to our office:

Authorization for Records Release

You will need Adobe Acrobat Reader installed on your system to view and print these sheets. If you don't, it can be downloaded free at www.adobe.com. If you prefer, a new patient packet can be mailed to you upon request by calling 407-644-4883.