Patient Medical History Form

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

		Patient Handouts

The Patient Medical History Form can be filled out right on your computer (it's much easier than doing it by hand) if you'd prefer. Just place your cursor in the first field, enter your information and tab to each succeeding field. When you're through, print the complete form and bring it in to your next appointment.

If you're using Adobe Reader® to fill out the form, you won't be able to save the filled-out form, so please don't close or quit the document until you're finished and the form is printed. Users of Adobe Acrobat® Standard or Professional are able to save the filled-out form if desired.

Please click below to open the form and continue.

Patient Medical History Form

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.