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Patient forms

Before your first visit to the office, we request that you kindly fill the two forms for your patient information as well as a disclosure form found below. Please bring these with you for your first visit.

Download, fill out and sign, then bring to office

  • Patient Information
  • Disclosure Statement

Print and Read

  • Bill of Rights
  • Notice of Privacy Practices

Instruction Sheets for Before and After Surgery

  • Nose & Sinus surgery
  • Rhinoplasty
  • Pituitary/Skull base
  • Office Surgery
  • Tonsillectomy
  • TNE (office scoping of food pipe)

Instruction Sheets for Medical Conditions

  • Dizziness/off-balance (Cawthorne sheet)
  • Nose bleed (Epistaxis)
  • Wax (Cerumen)
  • TMJ (Tempro-Mandibular Joint) Dysfunction Sheet
  • Salivary Gland swelling/infection

 

3003 New Hyde Park Road
Lake Success, NY 11042
TEL: 516-775-2800

Services

  • Endoscopic Sinus Surgery
  • Balloon Sinus Surgery
  • Septoplasty
  • Rhinoplasty
  • Skull Base/Pituitary Surgery
  • Nasal Fracture
  • Obstructive Sleep Apnea Surgery
  • Pediatric Surgery
  • Audiology & Hearing
  • Dizziness/Balance
  • Voice & Swallowing

 

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  • Endoscopic Sinus Surgery
  • Balloon Sinus Surgery
  • Septoplasty
  • Rhinoplasty
  • Skull Base/Pituitary Surgery
  • Nasal Fracture
  • Obstructive Sleep Apnea Surgery
  • Pediatric Surgery
  • Audiology & Hearing
  • Dizziness/Balance
  • Voice & Swallowing
  • ENT Doctors Dr. B. Todd Schaeffer and Dr. Moshe Ephrat, serving Lake Success, New Hyde Park, Floral Park, Garden City, Bellerose, Glen Oaks, Manhasset, Franklin Square, Malverne, Valley Stream, and all surrounding areas.

    Island ENT: 3003 New Hyde Park Road | Lake Success, NY 11042 | Tel: 516.775.2800

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