New Patient Forms

Your first visit to The Pediatric Airway Center of Chicago establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office(s), practice hours, payment policies and more. There’s background information about our first visit procedures. You can even save some time at your first visit by printing out and completing the new patient forms in advance of your appointment.

Please Click the Forms Below to Print them:

Patient Information

Patient Information Health History

Office Financial Policy

Request for Confidential Communication

Consent for Release & Use of Confidentail Info

Notice of Privacy Practices

Authorization of Confidential Health Info from ENT of IL

Authorization of Confidential Health Info to ENT of IL
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