About your Visit @ ENT Clinic of Iowa, P.C.

Our office staff may ask you to print and fill out one or more of the forms below. This saves you time and helps us process your paperwork faster. Please contact us directly @ 515.267.1800 with any questions on these forms.

We want to answer as many questions at your visit, please prepare for this by bringing the following information to your first visit:

Health Insurance Card/Information
A friend or family member to take notes/help with questions
A list of all medications you are taking
A list of your questions /concerns
CT Imaging (not just the reports - get the actual films)
Copies of records from doctors related to your sinuses/nose/allergies/lungs
Complete forms provided below

about your visit at ENT clinic of iowa

10 million Americans have hearing loss caused by noise.

Forms Require Free Adobe Reader Software - download here if needed

New Patient Adult Forms:

	New Patient Pack (Adult) - includes most forms below (does not include Snoring Questionnaire)
	New Patient Information
	New Patient (Adult) Medical History
	New Patient Consent Form (HIPAA)
	Notice of Privacy Practices
	Snoring Questionnaire

Patient Forms & Resources at ENT Clinic of Iowa

New Patient Child Forms:

	New Patient Pack (Child) - includes all forms below
	New Patient Information
	New Patient Child Medical History
	New Patient Consent Form (HIPAA)
	Notice of Privacy Practices
	Child sleep questionnaire