Medical History Form
Please click on the link below to obtain our medical history form. Then print the form and fill it out as completely as possible. Bring the completed form with you when you come for your appointment, or you may mail or fax the form to our office a head of time. If you have had any x-rays, CT scans or MRI's, please obtain them from where you had them done and bring them with you. It is important that we see the scans and not just the reports.
Mail to:
Professional Otolaryngology Associates
Staffordshire Professional Center, A-100
1307 White Horse Road
Voorhees, N.J. 08043
Fax to:
(856) 346-0757