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Click on any form icon below to download an Adobe Reader® document of that form. Where applicable, print and complete the form(s) and bring with you to your next appointment.

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New Patient Forms

 PDF TX-65 Registration
 PDF TX-65 Patient Health History
 PDF TX-65 Notice of Privacy Practices
 PDF TX-65 HIPAA Approved Contacts
 PDF TX-65 Credit Card Pre-Authorization
 PDF TX-65 Map & Directions

Hearing Patient Forms

 PDF TX-65 Adult Questionnaire
 PDF TX-65 Child Questionnaire

Allergy Patient Forms

 PDF TX-65 Sinus & Allergy Form
 PDF TX-65 Checklist for Beginning Allergy Shots
 PDF TX-65 Starting Allergy Shots
 PDF TX-65 Allergy Shots vs. Drops
 PDF TX-65 Sublingual Immunotherapy
 PDF TX-65 House Dust Information and Control
 PDF TX-65 Mold Allergy Prevention and Control
 PDF TX-65 Pollens
 PDF TX-65 Top 10 Ways to Decrease Cat Allergies

Sleep Patient Forms

 PDF TX-65 Sleep Center Quiz

Additional Forms

 PDF TX-65 Records Release
 PDF TX-65 Your Surgery Information

Midwest Ear, Nose & Throat
2315 West 57th Street  •  Sioux Falls, South Dakota 57108  •  605-336-3503  •  Toll-free 888-336-3503  •  Fax 605-336-6010