Patient Forms

		Patient Forms
		Patient Demographic Form
		Patient Medical History Form
		Consent for Purposes of Treatment
		ENT Treatment & Office Procedures
		HIPAA Authorization for PHI

		Patient Handouts

Patient Forms

Please complete the Patient Demographic Form, Patient Medical History Form and Consent for Purposes of Treatment Form before coming in for your appointment. If any patient information has changed since your last visit (i.e. insurance carrier, address, etc.) please also complete a new Patient Demographic Form as well.

Click on the icon below to download an Acrobat Reader® file for each form. If you don't have Acrobat Reader® on your computer, click here for a
free download.

Patient Demographic Form

Patient Medical History Form

Consent for Purposes of Treatment

ENT Treatment & Office Procedures

HIPAA Authorization for Use or Disclosure of PHI

We want to assure you your Personal Health Information will remain private and will be governed by our Privacy Policy. If you would like to release your medical information to someone special, please complete the HIPAA Authorization Form, print and sign a copy, and bring that with you to your appointment.

Thank you,

Colorado Adult and Children's Ear, Nose & Throat, P.C.

Sharon M. Tomaski, M.D.
Board Certified by the American Board of Otolaryngology
Fellow, American Academy of Otolaryngology - Head & Neck Surgery
Fellowship Trained in Pediatric Otolaryngology - Head & Neck Surgery

If you need to contact us, please call (303) 347-0800.
Documents and Forms posted on this site are in PDF format. If you have any difficulty viewing these documents, please click here.

Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.