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  • home

  • specialties
    • All Specialties
    • Allergy & Asthma
    • Audiology & Hearing Aids
    • Adult & Pediatric Dermatology
    • ENT / Head, Neck & Thyroid Surgery
    • Hand Surgery
    • Plastic & Reconstructive Surgery
    • Skincare & Laser
    • All Aesthetics
      • Aesthetics Services
      • Cosmetic & Plastic Surgery
      • Cosmetic Dermatology
      • Skincare & Laser
  • Providers
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    • All Locations
    • Danbury Office
    • New Milford Office
    • Norwalk Office
    • Ridgefield Office
  • Shop
  • Contact Us
Menu
  • home

  • specialties
    • All Specialties
    • Allergy & Asthma
    • Audiology & Hearing Aids
    • Adult & Pediatric Dermatology
    • ENT / Head, Neck & Thyroid Surgery
    • Hand Surgery
    • Plastic & Reconstructive Surgery
    • Skincare & Laser
    • All Aesthetics
      • Aesthetics Services
      • Cosmetic & Plastic Surgery
      • Cosmetic Dermatology
      • Skincare & Laser
  • Providers
  • Blog
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Patient Intake, Evaluation & Medical Release Forms

Select a form below to complete.

Audiology

  • Hearing Aid Payment Information
  • DX3 Testing Instructions
  • Español
  • DX4 Testing Instructions
  • Español

Allergy & Asthma

  • Allergy Patient Medication List (Testing Restrictions)

Administrative Forms

  • Submit Vaccination Card (digital form)
  • Medical Records Release Form (digital form)
  • Telehealth Appointment Consent Form (download)
  • Telehealth Appointment Consent Form (digital form)
  • Billing Communication (digital form)
  • Consent to Treatment of a Minor When Legal Guardian and/or Parent is not Present
  • Surgical Financial Waiver: Upper Blepharoplasty
  • Surgical Financial Waiver: Extensive Fat Grafting
  • Surgical Financial Waiver: Breast Reduction Mammaplasty Bilateral
  • Surgical Financial Waiver: Panniculectomy
  • Surgical Financial Waiver: Septoplasty
  • Surgical Financial Waiver: Remove/Replace Implants
  • Surgical Financial Waiver: Gynecomastia
  • Surgical Financial Waiver: Scars

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Call: M - F | 8AM - 5PM

(203) 830-4700

Ridgefield Office

901 Ethan Allen Hwy (Rte 7)
Suite #101
Ridgefield, CT 06877
M-F:  8:00am – 5:00pm

Norwalk Office

488 Main Avenue
Second Floor
Norwalk, CT 06851
M-Tr:  8:30pm – 5:00pm
F:  Closed

Danbury Office

107 Newtown Road
Danbury, CT 06810
M-F:  8:00am – 5:00pm

New Milford Office​

131 Kent Road
Second Floor
New Milford, CT 06776
M/T:  1:00pm – 5:00pm
W:  8:30am – 5:00pm
Tr:  Closed
F:  8:30am – 5:00pm

Danbury Office

107 Newtown Road
Danbury, CT 06810

New Milford Office​

131 Kent Road
Second Floor
New Milford, CT 06776

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