New patients will need to have these forms completed before initial office visit.
Patient History Form
Patient Insurance Form
Personal Medication Record Form
Dr. Leiders office may require you to document and keep records of your personal medication.
Fill out Medical Consent to Release Records form if your medical records need to be transferred to Dr. Leiders office prior to visit.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA)
Pre-operative Forms
- After Nose Surgery (PDF)
- Adenoidectomy before and after (PDF)
- Tonsillectomy before and After (PDF)
- Tympanostomy (PDF)
- Uvulopalatopharyngoplasty (PDF)
