Forms and Education

Patient Forms

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Patient Registration Form
Patient Registration
Adult Medical History Form
Adult Medical History
Pediatric Medical History Form
Pediatric Medical History
Medical Record Release Form
Medical Record Release
Consent and Payment Authorization
Consent and Payment Authorization
Notice of Privacy Practices
Notice of Privacy Practices

Patient Education

Click on any of the icons below to open an Adobe Reader® file of that document.

Air Travel
Air Travel Discomfort
Elimination Diet
Elimination Diet
Kenalog Injection
Kenalog Injection
Nosebleed Treatment
5 Things Physicians
and Patients Should Question


The Ear, Nose and Throat Clinic & Hearing Center
7300 France Avenue South, Suite 420  •  Edina, Minnesota 55435  •  Phone: 952-252-6552  •  Fax: 952-548-5254