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Phone: (612) 871-1144
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Our Locations
Apple Valley
Burnsville
Coon Rapids
Edina
Fridley
Maple Grove
Minneapolis
Plymouth
St. Paul
Affiliate Sites
Allina - Buffalo
Allina - Cambridge
Allina - Coon Rapids
Allina - Eagan
Allina - Hastings
Allina - Woodbury
HealthEast - Maplewood
HealthEast - Midway
River Falls

All Forms

 All the forms on this page require Adobe Reader. You may download Adobe Reader for free from the Adobe website.

Clinic Registration and Medical History forms can be printed.

These are provided for your convenience to fill out prior to your first visit and every three years.

Registration
  Patient Registration
  Adult Medical History
  Pediatric Medical History
 
Surgery
  Pre-Surgical Examination Form for Primary Care Physician
  Pre-Surgical Patient Instructions
  Post-op Instructions - Myringtomy/Tubes
  Postop Instructions - Tonsillectomy and/or Adenoidectomy
  Postop Instructions - Nasal Septoplasty
  Postop Instructions - Ear Operation
  Postop Instructions - Nasal Surgery
 
Other
  Authorization to Release/Obtain Medical Records
  Hearing Aid Assessment
  Auditory Brainstem Response Testing (ABR) Instructions
  Audio ENG / VNG Pre-Test Instructions
  Dizziness Questionnaire
  Additional Dizziness Questionnaire - Dr. Brown patients
  Snoring Questionnaire
 


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