Patient Form

At Ear, Nose & Throat Associates of New York, we strive to make your registration and check-in process as quick and as seamless as possible. In order to cut down on your wait time, we ask that you download and complete the applicable registration form from the list below. Please remember to bring the completed form and all supporting documentation with you on the date of your visit.

PATIENT REGISTRATION FORMS:

Patient Intake Form:
English New Patient Registration Form
Spanish New Patient Registration Form

SUPPORTING DOCUMENTATION REQUIRED:

  • Health Insurance Card
  • Referral, if required
  • Photo ID
  • Completed Patient Intake Form (above)

Thank you and we look forward to continuously providing you the exceptional service you have come to know and deserve.

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  • * All indicated fields must be completed.
    Please include non-medical questions and correspondence only.
  • This field is for validation purposes and should be left unchanged.

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