Forms & Surgical Instructions
Vernick & Gopal Ear, Nose & Throat Specialists Registration Forms
- Dr. Vernick-New Patient Registration
- Dr. Darr-New Patient Registration
- Dr. Gopal New Patient Registration Form
- ENT Pediatric New Patient Registration
- Dizzy Evaluation with Dr. Vernick
Vernick & Gopal Hearing Center Registration Forms
- Audiology New Patient Registration
- Audiology Updated Patient Registration (Established patient, but 3 years or over since last visit)
- Patient Profile of Hearing Aid Benefit
- Dix Hallpike/ Epley Maneuver Instructions and Questionnaire
Medical Releases
- Authorization to release Medical Records from Vernick and Gopal, LLC
- Authorization for outside medical records to be sent to Vernick and Gopal, LLC
In Office Procedures
Preoperative Instructions
Beth Israel Deaconess Medical Center:
Children's Hospital:
Day Surgery:
Post-operative Instructions for Your Child:
Postoperative Instructions
Ear Surgery
- Canalplasty
- Tympanoplasty/Ossiculoplasty/Middle Ear Surgery
- Stapedectomy
- Mastoidectomy/Tympanoplasty
Other
