{"id":6563,"date":"2020-02-14T09:36:36","date_gmt":"2020-02-14T17:36:16","guid":{"rendered":"https:\/\/entsalem.fm1.dev-11\/patient-resources\/ent-patient-resources\/"},"modified":"2023-09-18T11:48:58","modified_gmt":"2023-09-18T18:48:58","slug":"forms","status":"publish","type":"page","link":"https:\/\/entsalem.com\/ear-nose-throat\/ent-resources\/forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n

Current patients can access this section to download forms, learn more about medical and surgical procedures, and access a variety of useful links and informational videos.<\/em><\/p>\n\n\n\n

Patient Registration Forms<\/h2>\n\n\n\n
Welcome Letter<\/a>Download<\/a><\/div>\n\n\n\n

<\/p>\n\n\n\n

Patient Information Form (required)<\/a><\/p>\n\n\n\n

Medical History Form (required)<\/a><\/p>\n\n\n\n

Cancellation\/No Show Policy Form (required)<\/a><\/p>\n\n\n\n

Financial Policy Form with Privacy Acknowledgement (required)<\/a><\/p>\n\n\n\n

Other Forms<\/h2>\n\n\n\n
Medical Release<\/a>Download<\/a><\/div>\n\n\n\n
Privacy HIPAA Policy (English)<\/a>Download<\/a><\/div>\n\n\n\n
Privacy HIPAA Policy (Espa\u00f1ol)<\/a>Download<\/a><\/div>\n\n\n\n
Consent to Share Health History Information<\/a>Download<\/a><\/div>\n\n\n\n
Authorization for Treatment<\/a>Download<\/a><\/div>\n\n\n\n

Established minor patients may be seen with an adult other than a parent\/guardian if an Authorization to Treat form has been filled out and brought in for office visits. New Patient, Pre-op and Surgical appointments must have a parent or legal guardian present.<\/strong><\/p>\n\n\n\n

Post-Surgical Instructions<\/h2>\n\n\n\n

Below are downloadable instructions for the primary surgeries performed at River Road Surgery Center. Please contact us with any questions or concerns.<\/p>\n\n\n\n

Adenoidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Abenoidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Inspire Instrument Placement<\/a>Download<\/a><\/div>\n\n\n\n
Mastoidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Mastoidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Myringotomy and Ear Tube Placement<\/a>Download<\/a><\/div>\n\n\n\n
Myringotomy and Ear Tube Placement – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Nasal and Sinus Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Nasal and Sinus Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Neck Dissection<\/a>Download<\/a><\/div>\n\n\n\n
Neck Dissection – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Pain Control Regimen<\/a>Download<\/a><\/div>\n\n\n\n
Parathyroidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Parathyroidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Parotidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Parotidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Post-operative Pain Control Regimen<\/a>Download<\/a><\/div>\n\n\n\n
Septo Turbinoplasty Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Septo Turbinoplasty Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Stapedectomy<\/a>Download<\/a><\/div>\n\n\n\n
Stapedectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Submandibular Gland<\/a>Download<\/a><\/div>\n\n\n\n
Submandibular Gland – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Throat or Vocal Cord Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Throat or Vocal Cord Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Thyroidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Thyroidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Tonsil & Adenoid Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Tonsil & Adenoid Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Tympanoplasty<\/a>Download<\/a><\/div>\n\n\n\n
Tympanoplasty – Spanish<\/a>Download<\/a><\/div>\n\n\n\n

Procedure Information Sheets<\/h2>\n\n\n\n
Information on Adenoidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Adenoidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Mastoidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Mastoidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Myringotomy and Ear Tube Placement<\/a>Download<\/a><\/div>\n\n\n\n
Information on Myringotomy and Ear Tube Placement – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Nasal and Sinus Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Information on Nasal and Sinus Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Neck Dissection<\/a>Download<\/a><\/div>\n\n\n\n
Information on Neck Dissection – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Parathyroidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Parathyroidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Parotidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Parotidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Septoturbinoplasty Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Information on Septoturbinoplasty Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Stapedectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Stapedectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Submandibular<\/a>Download<\/a><\/div>\n\n\n\n
Information on Submandibular – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Throat or Vocal Chord Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Information on Throat or Vocal Chord Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Thyroidectomy<\/a>Download<\/a><\/div>\n\n\n\n
Information on Thyroidectomy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Tonsil Adenoid Surgery<\/a>Download<\/a><\/div>\n\n\n\n
Information on Tonsil Adenoid Surgery – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Information on Tympanoplasty<\/a>Download<\/a><\/div>\n\n\n\n
Information on Tympanoplasty – Spanish<\/a>Download<\/a><\/div>\n\n\n\n

Migraine Information<\/h2>\n\n\n\n
Migraine – More than a Headache<\/a>Download<\/a><\/div>\n\n\n\n
Migraine Grocery List<\/a>Download<\/a><\/div>\n\n\n\n
Sinus vs. Migraines<\/a>Download<\/a><\/div>\n\n\n\n

Patient Care Instructions<\/h2>\n\n\n\n
Coughs Colds Antibiotics<\/a>Download<\/a><\/div>\n\n\n\n
Cawthorne’s Head Exercises<\/a>Download<\/a><\/div>\n\n\n\n
Cawthorne’s Head Exercises – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Ear Drainage After Tube Placement<\/a>Download<\/a><\/div>\n\n\n\n
Ear Drop Instructions<\/a>Download<\/a><\/div>\n\n\n\n
Information About Tinnitus<\/a>Download<\/a><\/div>\n\n\n\n
Low Tyramine Headache Diet<\/a>Download<\/a><\/div>\n\n\n\n
Mediterranean Diet Info<\/a>Download<\/a><\/div>\n\n\n\n
Nosebleed Treatment Protocol<\/a>Download<\/a><\/div>\n\n\n\n
Nosebleed Treatment Protocol – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Recommendations for the Common Cold<\/a>Download<\/a><\/div>\n\n\n\n
Salt Water Rinse for the Nose<\/a>Download<\/a><\/div>\n\n\n\n
Self-Treatment of Right and Left-Sided BPPV<\/a>Download<\/a><\/div>\n\n\n\n
Starting an Exercise Program<\/a>Download<\/a><\/div>\n\n\n\n
Treatment of Laryngeal and Esophageal Reflux<\/a>Download<\/a><\/div>\n\n\n\n
Treatment of Laryngeal and Esophageal Reflux – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
TMJ After Your Visit<\/a>Download<\/a><\/div>\n\n\n\n
TMJ After Your Visit – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
TMJ Pain<\/a>Download<\/a><\/div>\n\n\n\n
Vocal Health for Singers and Educators<\/a>Download<\/a><\/div>\n\n\n\n

Neck Mass Patient Information<\/h2>\n\n\n\n
Neck Mass FAQ – English<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass FAQ – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Anesthesia – English<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Anethesia – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Biopsy – English<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Biopsy – Spanish<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Follow-Up – English<\/a>Download<\/a><\/div>\n\n\n\n
Neck Mass Follow-Up – Spanish<\/a>Download<\/a><\/div>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Current patients can access this section to download forms, learn more about medical and surgical procedures, and access a variety of useful links and informational videos. Patient Registration Forms Patient Information Form (required) Medical History Form (required) Cancellation\/No Show Policy Form (required) Financial Policy Form with Privacy Acknowledgement (required) Other Forms Established minor patients may…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":206,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":"","footnotes":""},"service_tags":[],"_links":{"self":[{"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/pages\/6563"}],"collection":[{"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/comments?post=6563"}],"version-history":[{"count":52,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/pages\/6563\/revisions"}],"predecessor-version":[{"id":10013,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/pages\/6563\/revisions\/10013"}],"up":[{"embeddable":true,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/pages\/206"}],"wp:attachment":[{"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/media?parent=6563"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/entsalem.com\/wp-json\/wp\/v2\/service_tags?post=6563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}