patient forms
We recommended that you fill out our forms prior to your visit in order to expedite processing and serve you better. If you would like assistance filling out the forms, please print out and bring them with you 15 minutes prior to your appointment time.
Provider Referral
If you are referring a patient, please download the Provider Referral form and fax it to 920-356-6419:
Patient Referral Form
Download Patient Forms
Please bring your completed forms with you to our office at the time of your visit. All patients please print off and complete the following forms:
HIPAA Acknowledgement
Verbal Communication & Voicemail Authorization
Patient Information Intake Form
Throat Irritation Questionnaire
Allergy
If you have an appointment that is allergy-related, please also fill out the following form:
Allergy History Form
Sleep
If you have an appointment that is sleep-related, please also fill out the following forms:
Sleep Problems Checklist
Sleep Screening Questionnaire
Have Additional Questions?
No worries, get in touch! We are happy to chat over any questions you may have.