Patient Forms

FOR YOUR VISIT:

The following forms have been made available for new otolaryngology patients. Prior to your first visit with us, download and print the appropriate form (Adult or Pediatric). Please complete the form and bring with you to your initial appointment.

Click this link to access the ADULT Medical History Form.

Click this link to access the PEDIATRIC Medical History Form.

MEDICAL RECORD REQUESTS:

If you'd like a copy of your medical record, please vist the BWH website for Medical Records Requests as the Division of Otolaryngology does not keep charts separate from Brigham and Women's Hospital.

Click this link to access the ENGLISH BWH Medical Record Release Form.

Click this link to access the SPANISH BWH Medical Record Release Form.