Patient Forms

Please complete and submit the New Patient History Form, Patient Information Form and Sleep Apnea Screening Form prior to your first appointment.

If you are a continuing patient and any of your information has changed, please complete the appropriate form and submit before your next appointment.

These Patient Forms are hosted on a secure server, and any Personal Health Information that you submit will be encrypted and stored on that server. ENT Associates of Southern Indiana will not allow access to any of this information to any third party, except as specified in our Notice of Privacy Practices below. Disclosure Authorization Notice of Privacy Practices Patient Registration New Patient History Sleep Apnea Screening Click on any image above to access that form