Patient Forms

For your convenience, the forms you’ll need for your first visit and for requesting health information are listed below.

New Patient Forms

If you are a new patient, please complete these forms and bring them 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 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