New Patient Forms

If you are a new patient, please complete these forms and bring them with you 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.

• Authorization to Release Medical Information
• Autorización para Divulgar Información Médica

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