Columbus Otolaryngology Clinic
 

Forms

Financial Forms
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Financial Form - English Link to Columbus Otolaryngology Financial Form - Spanish
Notice of Privacy Forms
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Noice of Privacy Practices Form - English Link to Columbus Otolaryngology Noice of Privacy Practices Form - Spanish

Patient Forms - Adult
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Patient Form - Adult - English Link to Columbus Otolaryngology Patient Form - Adult - Spanish
Patient Forms - Minor
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Patient Form - Minor - English Link to Columbus Otolaryngology Patient Form - Minor - Spanish

Medical History Forms
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Medical History Form - English Link to Columbus Otolaryngology Medical History Form - Spanish
Out Patient Consent Forms
English/Inglés  Spanish/Español
Link to Columbus Otolaryngology Out Patient Consent Form - English Link to Columbus Otolaryngology Out Patient Consent Form - Spanish

Medicare Secondary Payer Forms
English/Inglés 
Link to Columbus Otolaryngology Medicare Secondary Payer Form - English

Columbus Otolaryngology Clinic

American Board of Otolaryngology Certified - Founding Member of the American Board of Medical Specialties (ABMS)

Nila M. Novotny, M.D.

Paul S. Sherrerd, M.D.

James M. Weekly, M.D.

 

4508 38th St., Suite #152

Columbus, NE 68601-1668

402-562-4720 FAX: 402-562-4721

Emergency call 911

 

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