Skip to main content

Patient Forms

Request Appointment

(503) 513-8693
  • Home
  • About


    • Request Appointment
      Patient Forms
    • Home
    • About

      • About Us
      • Meet Our Team
      • Culture & Careers
    • Resources

      • Patient Education
      • Patient Forms
      • Request Appointment
      • Contact
    • Live vibrantly. โ€จ
      Breathe freely.
      Hear clearly.

  • Location


      • Milwaukie Office

        10024 SE 32nd Ave
        Milwaukie, OR 97222
        (503) 513-8693
        (503) 659-2191
        Mon: 8:00am – 4:30pm Tues: 8:00am – 4:30pm Wed: 8:00am – 4:30pm Thur: 8:00am – 4:30pm Fri: 8:00am – 4:30pm
        Open in Google Maps
  • Call
  • Services


    • ENT Services

      • Ear Services
      • Nose & Mouth Services
      • Throat Services
      • Sleep
      • Allergy
      • Head & Neck Services
      • Thyroid & Parathyroid Services
      • Pediatric Services
    • Audiology

      • Hearing Services
      • Resources
      • Hearing Aid Styles
      • Accessories
      • Hearing Aid Batteries
      • Insurance


    Back to services menu
    • Hearing Services

    • Hearing Tests
    • Hearing Aid Fitting
    • Tinnitus Treatment
    • Child Hearing Treatment
    • Hearing Aid Repairs
    • Balance Treatment
    • Auditory Processing Evaluation
    • Earwax Management
    • Aural Rehabilitation
    • Custom Hearing Protection
    • Musician Monitors & Custom Earbuds

    Seeking Patient Customized
    Hearing Healthcare?

    We Can Help!


    Back to services menu
    • Resources

    • Hearing Loss Guide
    • Signs of Hearing Loss
    • Communication Tips
    • Binaural Hearing
    • Related Health Problems
    • Types of Hearing Care Providers
    • Real-Ear Measurement for Hearing Aid Fitting and Adjustments
    • How to Protect Your Hearing
    • Hearing Health & Dementia Prevention


    Back to services menu
    • Hearing Aid Styles

    • Invisible Hearing Aids
    • Completely-in-Canal
    • In-the-Canal
    • In-the-Ear
    • Receiver-in-Canal
    • Behind-the-Ear

    Seeking Patient Customized
    Hearing Healthcare?

    We Can Help!


    Back to services menu
    • Accessories

    • Hearing Aid Cleaning & Care Products
    • Streaming Products & Apps
    • Assistive Listening Devices

    Seeking Patient Customized
    Hearing Healthcare?

    We Can Help!
  • Search


    • Request Appointment
      Patient Forms
  • Notices


    Notices

    • Severe weather closure
      3 years ago
    • Mask mandate in place
      3 years ago
    • Dr. Smith is retiring!
      3 years ago

Patient Forms

January 6, 2022
Adult Patient Form
Download
Patient Child FormDownload
Companion QuestionnaireDownload

Contact Us

If you are experiencing a medical emergency, please call 911.

Please complete the form and our team will contact you during our regular business hours.

"*" indicates required fields

  • Milwaukie Office

    10024 SE 32nd Ave
    Milwaukie, OR 97222
    (503) 513-8693 (503) 659-2191
    Mon: 8:00am – 4:30pm Tues: 8:00am – 4:30pm Wed: 8:00am – 4:30pm Thur: 8:00am – 4:30pm Fri: 8:00am – 4:30pm

Quick Links

  • Home
  • About
  • Meet Our Team
  • Ear, Nose & Throat
  • Audiology
  • Allergy
  • Sleep
  • Request Appointment
  • Contact Us
Copyright © 2026 Northwest ENT and Allergy. All Rights Reserved.
  • Accessibility
  • Policies
  • Sitemap