Patient Forms
Make an Appointment
Our team is here to help you make an appointment with the specialists that you need.
For your convenience, the forms you’ll need for your first visit and for requesting health information are listed below.
New Patient Forms
If you are a new patient, please complete these forms and bring them to your first visit.
- New Patient Intake Form Adult
- Nuevo Paciente Formulario de Admisión Adulto
- New Patient Intake Form Pediatric
- General Patient Information Form
- Notice of Privacy Practices
- Aviso Sobre Las Prácticas de Privacidad
- Notice of Privacy Practices - Patient Acknowledgement
- Aviso Sobre Las Prácticas de Privacidad - Reconocimiento de Recibo
Authorization for Release of Health Information
If you would like us to release any of your health information to another party, you must fill out a written authorization.
Please complete the form above and return it by fax or mail to:
Columbia Otolaryngology-HNS
Medical Records Department
180 Fort Washington Ave., 7th Floor
New York, NY 10032
Phone: 212-305-8555
Fax: 212-305-2249