Forms

Consent To Release Medical Records

This form allows us to either obtain records from another office, (for example to get records ahead of time for an upcoming visit at West Michigan ENT & Allergy). 

Also, you can use this form to have your West Michigan ENT & Allergy records sent to another location.

Click here to download printable form (PDF). Consent to Release Medical Records.


New Patient Forms

Filling these forms out ahead of time can save you time at our office!

Click here to download printable form (PDF).  Patient Health History.

Click here to download printable form (PDF).  Personal and insurance information.


HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  

West Michigan ENT & Allergy will follow all standard regulations regarding your privacy and records.  Please notify us right away if you have any concerns about your privacy. 

Click here to download printable form (PDF).  HIPAA Notice of Privacy Practices.