Forms

Please find a listing of forms and instructions below that will provide useful information to you and expedite your visit to Eastern Oklahoma Ear, Nose & Throat. These forms are in a PDF format, and you will need Adobe Acrobat to open these files. If you do not already have Adobe Acrobat installed, you can download a free version here.

Patient Registration and Authorization -mandatory- This form is part of the registration paperwork that must be filled out prior to or during yoru first visit with EOENT. This form includes insurance and contact information.

Patient Medical History -mandatory- This must be filled out during or prior to your first visit to EOENT.

Minor Treatment Authorization Form – This must be filled out if the parent/guardian will NOT be present for the appointment.

Notice of Privacy Practices -mandatory-

Notice of Privacy Practice Acknowledgement Form -mandatory-

Dizziness Questionnaire – This must be filled out during or prior to your first visit to EOENT.

Snoring/Sleep Apnea Questionnaire

Request for Release of Medical Records Form