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.


  • 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
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