Ear, Nose and Throat Clinic of the Northwest Formerly Vancouver ENT and ENT Clinic of the Northwest 
Ears Nose Throat
September 02, 2010
 
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Office Hours:
Monday-Friday  8am-5pm
Saturday Closed
Sunday Closed
 
Billing Office Hours:
Monday-Friday  9am-5pm
Saturday Closed
Sunday Closed
Contact one of our three convenient locations

Ear, Nose and Throat Clinic of the Northwest Forms

Information for prospective patients or patients with pending appointments.[]

Feel free to download and print the registration form and health history form below for your upcoming appointment. After you have downloaded and printed your forms, please fill them out and bring the completed forms with you to your appointment.

Forms and form description are as follows:


Patient Registration Form

 

Health History Form

Patient Registration Form   Health History Form
Basic information about the patient, such as Name, Address, and Insurance.   A brief survey of previous and a brief survey of previous existing medical history.
Download PDF (99 KB)   Download PDF (53 KB)


Hearing Loss History Form

 

Financial Policy

Hearing Loss History Form   Financial Policy
A brief survey of previous existing medical
history and existing hearing loss history.
  Outlines our financial agreement with patients.
Download PDF (32 KB)   Download PDF (72 KB)

Notice of Privacy Practices — Receipt of Notice of Privacy Practices

Notice of Privacy Practices — Receipt of Notice of Privacy Practices
Notice of Privacy Practices — Receipt of
Notice of Privacy Practices Written Acknowledgement form.
Download PDF (624 KB)
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of the Northwest. All Rights Reserved.