Surveys

Allergy Health Survey

Ear Infection Survey

Epworth Sleepiness Scale

Hearing Survey

Nose Health Survey

Overall Health Survey

Tonsil and Adenoid Survey

 Patient's Zone - Forms

You can speed your appointment along if you download and complete the appropriate patient form below. Bring this with you to your appointment or fax it to 919-668-6036.

You will need Acrobat Reader to view and print the file. Acrobat Reader is free and can be obtained from the Adobe site.

New Patient Form

Patient Return Visit Form

Medical History Release Form

Patient Visit–Specific Questionnaire

In order to know how we're doing and how we might better serve you we invite you to complete the following form after your office visit.

Month

Year

1. How long you waited to get an appointment:

2. Convenience of the location of the office:

3. Getting through to the office by phone:

4. Length of time waiting at the office:

5. Time spent with the person you saw:

6. Explanation of what was done for you:

7. The technical skills (thoroughness, carefulness, competence) of the person you saw:

8. The personal manner (courtesy, respect, sensitivity, friendliness) of the person you saw:

9. The visit overall:

You may also download a PDF of the Patient Visit-Specific Questionnaire and fax it to us at 919-668-6036 .
Click here to download the questionnaire.

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All rights reserved.