test
test
test
test
test

Patient Forms

All new patients & patients who have not been seen within the last 6 months will be asked to bring the following items.

  • Driver's License or other phote ID; and/or
  • Utility bills or other correspondence showing current residence if the photo ID DOES NOT show the patient's current address
  • Current health insurance card;
  • If patient is a minor, the patient's parent or guardian should bring the infromation listed above.

Also, prior to coming to our office, please complete the following forms:

 

 

If you are visiting our office due to dizziness, please fill out the following:

Dizziness Questionnaire

 
If you have experienced tinnitus (ringing in the ears), please fill out the following:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
test

Telephone:210.696.4327
Fax:210.798.2509

Ear Institute of Texas
18518 Hardy Oak Blvd,
Suite 300,
San Antonio Tx 78258

Click here for a map of our office location



 
www.EIofTX.com