Spokane Valley Ear, Nose and Throat and Facial Plastics

Spokane Valley Ear, Nose and Throat has a full staff of doctors who are all board certified.
Omar Husein, M.D. / Geoffrey G. Julian, M.D. / Charles F. Benage, M.D. / G. Bruce McClelland, M.D. / Eric B.Leavitt, M.D.

Please print and complete the forms below and bring with you to your appointment

New Patients

Existing Patients

New Patient Letter
Financial Policy
New Patient History (Complete for all patients)
Adult Patient Information
Privacy Practices Acknowledgement
Minor Patient Information (Under 18)
Advance Consent to Treat Minors

Adult Patient Information
Minor Patient Information (Under 18)
Patient History

Release of Records Form

Privacy Statement

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