PATIENT INFORMATION AND MEDICAL FORMS
Please print out and complete both forms. You can mail
or fax information to us or bring with you to your appointment.
1405 Centerville Rd - Suite 5400
Tallahassee, FL 32308
(850) 877-0101
(850) 877-2750 (Fax)

Patient Information Form

Patient Medical Information Form

HIPAA Notice of Patient Privacy

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Tallahassee Ear, Nose & Throat, P. A.
1405 Centerville Rd. - Suite 5400
Tallahassee, FL 32308
(850) 877-0101
info@tallyent.com