Wichita Ear Clinic New Patient Forms

Save time by completing your New Patient Health Forms prior to your appointment. Click on the form links below.

OPTION 1
1) Type and enter your information directly onto the form using your computer.
2) With your printer connected, print the completed form.
3) Bring the completed form(s) with you to your appointment.

OPTION 2
1) Print the form and handwrite your information.
2) Bring the completed form(s) with you to your appointment.

Wichita Ear Clinic Patient Information Form

Wichita Ear Clinic Health Information Management Consent Form (HIPAA)

Wichita Ear Clinic Health History Form