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Patient Forms

New Patient Forms

If you are a new patient, please complete these forms and bring them with you to your first visit.

Authorization for Release of Health Information

If you would like us to release any of your health information to another party, you must fill out a written authorization.

Please complete the form above and return it by fax, email or mail to:

Columbia Otolaryngology-HNS
Medical Records Department
180 Fort Washington Ave., 7th Floor
New York, NY 10032
Phone: 212-305-8555
Fax: 212-305-2249
Email: Medrecrequest-otohns@columbia.edu