Patient Information Sheet

This site contains two ways of viewing and printing the Nose and Sinus Center's Patient Information Sheet. Once completed, this document can be sent to Dr. Becker's office in advance of your appointment, or brought with you for your appointment.

This Patient Information Sheet greatly assists the doctor in assessing and recommending care, after examination. Please make sure to fill in every applicable item.

For printing purposes, and due to varying browsers, printers, etc., this document is available for printing in two formats:

HTML format - not requiring any plug-ins. If this does not print correctly, use the
Adobe Acrobat format* - which requires that you have a recent version of Adobe Acrobat Reader installed on your computer.

* NOTE: If you don't have the Acrobat Reader plug-in, you can download it FREE from Adobe's site at http://www.adobe.com/products/acrobat/readstep2.html. You will need to select your computer's type and operating system (Windows 95 or 98, etc.) and fill in some additional information, and then click on the DOWNLOAD button. Notice that you can select the folder to which the file should be downloaded. Just be sure you remember where it's going and what it's named so you can find it later. (For Macintosh users, the file usually saves to the Desktop.)

After downloading is complete, you need to install. Close all open applications first. You can use either "My Computer" (Windows) or Desktop (Macintosh) to find and open the file you downloaded. After installation, when you're on the web and you click on a link that has the extension ".pdf," Acrobat Reader should automatically open and show your document. Note: If you are using Microsoft Internet Explorer version 4.0, you might need to download an additional file, information on this can be found at http://www.assist.org/7help/ar_ie4.html.

 

NOTE: All website users must agree to the terms and conditions of this site. PLEASE CLICK HERE TO REVIEW TERMS OF USE.

CLICK HERE FOR OUR PLEDGE REGARDING PRIVACY OF MEDICAL INFORMATION

Copyright@2003, Daniel G. Becker, MD
All Rights Reserved
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