Patient Info
Patient Forms
The documents listed below can be printed for you to fill out at your leisure in order to be sure all your information is accurate and complete.
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.
Some of the following documents may be required for you to fill out prior to your appointment. Please do not forget to bring your forms with you to your appointment and any other pertinent information ie: xrays, lab, work, or office notes from referring physicians.
- Patient Registration
- Patient History
- Permanent History
- Signature On File
- Epworth Sleep Scale
- Tinnitus Handicap Inventory
- Dizziness Questionnaire
- Sinus Intake Form
- SNOT-20
The following documents are strictly for informative purposes and can be printed and kept for your files:
Individuals who have been a patient at Rocky Mountain Ear, Nose, & Throat Center, P.C. have the right to access or receive copies of their medical records. Authorization for Release of Health Care Information forms can be obtained at the ENT front desk M-F 8:00am – 5:30pm or you may print them, fill them out and return to our office either by mail or stopping by our office:
Rocky Mountain Ear, Nose, & Throat Center, P.C.
Address: 700 W. Kent, Missoula, MT 59801. OR you may fax it to (406) 541-3950.
Links
Click on any name listed below for a direct link to that site.