Patient Forms

Please be sure your information is up-to-date

Patients are responsible for providing accurate, up-to-date information. You can update your insurance, personal and medical information from within "My Health Record" by logging into your patient portal. If you need instructions on how to log in, click the ESC Logging Into Patient Portal Instructions PDF file below. As you may have several physicians, this information can change without the treating doctor being aware of these changes. We ask that you login prior to any scheduled appointment to keep this information current.

New Patient Registration Form

Please complete this form if you are a new patient and bring it to your appointment if you have not already done so through the online patient portal.

ESC Logging Into Patient Portal Instructions

Patient portal how to log in as well as tips to view payment summary

Financial Policy

Please read and sign if you are a new patient and bring it with you to your appointment.

Personal Health Information Release Form

Please complete and sign the authorization form if you would like your personal health information released to another provider.

24 Hour Urine Calcium Instructions

Patient Instructions for 24 Hour Urine Calcium Collection

Hearing Difficulty Questionnaire

Questionnaire to assess if you may be experiencing possible hearing loss.
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