North Florida Center for Otolaryngology
Physicians
 

The following forms are required for new patients.
Please click on each form to download it. Then print it and bring it with you to your clinic visit.

Patient Registration and Patient Record of Disclosure

Medical History and Physical

Financial Agreement

Notice of Privacy Practices


 

N. Fl. Center for OTO-HNS philosophy is to provide our patients with high- quality, cost-effective health care.

Dr. Taliaferro | Dr. Miller | Dr. Leake | Practice Profile | Services | Hearing Aids | Forms | Contact
2010 © N. Fl. Center for OTO-HNS - 3 San Bartola Drive - St. Augustine, FL 32080 | 904.823.8823 [tel] | 904.808.8587 [fax]

site design: Avid Design Group, LLC - site maintained: Revelle Designed, Inc.