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New York Ear Home
Forms cannot be emailed to Dr. Hammerschlag's office due to HIPAA and patient confidentiality concerns.
Please fill in each form online, PRINT and SIGN, then fax or mail the forms (or bring with you to your appointment).
Our site uses Adobe Acrobat forms. Click here to download the free Adobe Acrobat Reader.
Online Patient Forms
Please print and complete the appropriate forms before your visit.
We try to keep information on all our patients as current as possible. If any of important information has changed since your last visit (i.e. insurance carrier, address, etc.) please complete a new Patient Information form as well.
Click each link below to download an Acrobat Reader® file for each form. If you don't have Acrobat Reader® on your computer, click here for a free download.
Patients can fill out forms online, PRINT the forms and either
- Bring them to your appointment
- Fax them to Dr. Hammerschlag's office at 212-679-9207
- Postal mail them to Dr. Hammerschlag's office
Dr. Paul E. Hammerschlag, MD, FACS
650 First Avenue
New York, New York 10016 - Be sure to SIGN forms where required before mailing or faxing
to Dr. Hammerschlag
The following forms are available online and open in a new window or tab:
Vertigo Dizziness Questionnaire (Download & fill out only if you are seeing the doctor for vertigo or dizziness symptoms).
Notice of Privacy Practices (You do not have to download this form, but you should read it online).