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New Patient Forms

If you are new to Colorado Springs Ear Associates please complete and bring the following form with you to your appointment.

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Financial and Privacy Policies

Please review our Financial and Privacy Policies. You will be required to sign Financial and HIPAA policy acknowledgments when you arrive for your appointment.

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Medical Records Release

Please use this form to request a copy of your medical records. Please mail the completed form or fax your request to 719-667-1328.

Download Form

Colorado Springs Ear Associates cannot guarantee that any file available for download from this site is free from viruses or other conditions which could damage or interfere with data, hardware, or software. You assume all risk for the use of all programs and files on this site. Colorado Springs Ear Associates and its contracted vendors are released of all responsibility for any consequences of its use.

Colorado Springs Ear Associates

2950 Professional Place, Suite 100
Colorado Springs, CO 80904

Phone: 719-667-1327


Fax: 719-667-1328

Hours of Operation
Monday: 8:00 AM – 5:00 PM
Tuesday: 8:00 AM – 6:00 PM
Wednesday: 8:00 AM – 6:00 PM
Thursday: 8:00 AM – 6:00 PM
Friday: 8:00 AM – 6:00 PM

Contact Colorado Springs Ear Associates Today
to Schedule an Appointment