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AUTHORIZATION×FOR×RELEASE×OF×MEDICAL×RECORDS* !TO×REQUEST×RELEASE×OF×MEDICAL×INFORMATION×PLEASE×COMPLETE×AND×SIGN×THIS×FORM* I, Hereby!voluntarily!authorize!the!disclosure!of!information!from!my!health!
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Burlington Ear Nose and Throat (ENT) is a medical practice specializing in conditions relating to the ear, nose, and throat.
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The purpose of Burlington Ear Nose and Throat is to diagnose and treat conditions related to the auditory, nasal, and pharyngeal systems.
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Patients must report personal identification details, medical history, medications, symptoms, and any previous treatments related to ENT issues.
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