Patient Forms

Posted on by Midwest ENT Centre
The raw Team

New Patient Information

Please plan to arrive 15 minutes prior to your scheduled appointment time. Bring your driver’s license, medical insurance card(s), insurance referral if needed, and your co-pay for seeing a specialist, if applicable. Please bring any related medical records, test results and imaging films that should be given to the doctor.

Patient forms are available for download below. Please print out and complete the Patient Registration and Medication forms to bring with you to your appointment. There may be additional forms for you to complete upon your arrival.

First Visit Forms

Thank you for choosing Midwest ENT Centre. We’re excited to see you.

To make your first visit more enjoyable, please print and fill out the following forms before your appointment, so we can expedite your time in our waiting room:

Patient Registration FormDownload
Minor New Patient Registration FormDownload
Minor Consent FormDownload
Medications ListDownload
Privacy Practices PamphletDownload
Know Your Rights DocumentationDownload
In-office Procedure Consent Financial InfoDownload

For release of your medical records, please print out and complete the following form:

Medical Records Release FormDownload

Patient Portal Forms:

Patient Portal Registration InstructionsDownload

Instructions to create a proxy account so you can access your child or dependent adult’s portal account:

Patient Portal Proxy Registration Instructions Download