Our practice requires that these forms be completed for your first visit and once a year to ensure the accuracy of your information. You may complete these patient forms before your office arrival.
- Patient Demographic Form
- Health History
- HIPAA Disclosure
- Insurance Responsibility Form
- In Office Procedure Insurance Form
- SNOT 22 Questionnaire
- ETD-Q7 Assessment (complete if you have ear problems)
- If you have a medication list, please bring it with you to your appointment.
Please print the forms and bring them with you to your appointment or save them as a PDF file and email them to [email protected]
If you have been treated for a sinus or allergy problem, we would like to obtain a copy of your medical records for Dr. Sikand to review. Due to privacy laws, we will need a form signed to obtain them.
- Medical Records Release (to our office)
- Permission To Release ENTC Records (if you’d like us to send your records to you or to another healthcare provider)
- If an attorney, employer, or government agency is requesting a copy of your records, they will need to call our medical records department at (702) 792-6700 ext. 1102 or send a fax to (702) 255-8697.
Above all, it is important to let us know if you have any changes to your health history. Please notify us of any changes in medications, surgeries, or been diagnosed with other medical conditions since you’re last visit.