If you have not visited us yet, please fill out the following packet and bring it in when you come for your appointment. Please be sure to come 15 minutes early.
New Patients
To save you time at check-in, we request that you complete the New Patient Packet beforehand.
Individual Forms
Allows the patient to authorize the release of their medical information from Glacier Ear, Nose & Throat.
Allows the patient to authorize the release of their medical information to be sent to Glacier Ear, Nose & Throat.
Authorizes Glacier Ear, Nose & Throat to set up regular credit card payments on patient accounts. Prior authorization with our Billing Department is required for use of this program.
Documents personal and insurance information.
Documents how Glacier Ear, Nose & Throat is required to keep our patient’s information and medical records private.
Allows Glacier Ear, Nose, & Throat permission to speak with a member of your family or a friend about your medical and billing information.
A form to be used by patients to secure a referral for a hearing test from their primary provider.
Informed Consent Documents for Patients with a Scheduled Surgery