Department of Otolaryngology
Patient Forms
Patient Pre-Registration
Before your appointment, you can provide
your information through our secure patient pre-registration form.
Because we value
your privacy, your personal information will not be used by the
Strong Health Department of Otolaryngology other than
to schedule
an appointment. Before submitting your information,
you may also wish to review our Notice
of Privacy Practice and
Disclaimer.
Please Note
Online registration forms are checked
Monday - Friday 8:30 a.m. - 5:00 p.m., except holidays. Allow
one business day for your pre-registration form to be processed.
If
you do not receive confirmation of your request, please contact
our office at 585-758-5700.
Forms
- General Patient Pre-registration Form - Fill out our ONLINE FORM or PRINT PAGE
- Laryngology Patient Pre-registration
Form (Dr. Haben's patients) - Fill out our ONLINE FORM or PRINT PAGE
- Pulli Patient Pre-registration
Form (Dr. Pulli's patients) - Fill out form - PRINT PAGE
- Vertigo Patient Pre-registration Form (Dr. Dutcher's patients) - Fill out our ONLINE FORM or PRINT PAGE
|
