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Patient Forms

All new patients, prior to coming to our office for their first visit, need to complete the following forms:

General Health Information
 

Special Questionnaires

Not all new patients need to complete the following forms. Please read the descriptions below to determine whether or not you should complete the questionnaires.

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

Dizziness Questionnaire
If your main reason for seeing the doctor is tinnitus (ringing in the ears), please fill out the following questionnaire.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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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

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www.EIofTX.com