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Arizona Sinus Center

Snoring & Sleep Apnea

Thyroid & Parathyroid Surgery

Facial Aesthetic Care

Head & Neck Cancer

Laryngology & Voice Disorders

Ear Disorders

HomeWhat Is An OtolaryngologistMeet Our PhysiciansFor PatientsAbout Your VisitPatient FormsPatient InstructionsWhat Is An OtolaryngologistMeet the StaffOur PhysiciansHelpful LinksLocations & ContactsFor PhysiciansOur ServicesAbout Dr. NutleyAbout Dr. RehlLocations & ContactsLocations & ContactsAbout Your VisitPatient FormsMap & DirectionsContactsArizona Sinus CenterRhinosinusitis 101Medical Care of the Nose & SinusesSurgical Care of the SinusesSurgical Treatment of Obstructed Breathing & Nasal CongestionSnoring & Sleep ApneaWhat is Obstructive Sleep Apnea?Medical Treatment of Snoring & Sleep ApneaSurgical Treatment for SnoringSurgical Treatment for Obstructive Sleep ApneaThyroid & Parathyroid SurgeryWhat does the Thyroid Gland do?What are the Parathyroid Glands?Thyroid Eye DiseaseFacial Aesthetic CareRhinoplasty (nose reshaping)Skin Cancer TreatmentScar Revision & CamouflageHead & Neck CancerFacial, Head & Neck Skin CancerEvaluation & Management of Congenital or Acquired Neck MassesEvaluation & Management of Salivary GlandLaryngology & Voice DisordersEvaluation & Management of Hoarseness & Other Voice DisordersMedical Treatment of Laryngeal & Voice DisordersSurgical Treatment of Laryngeal & Voice DisordersEar DisordersMyrinotomy with Tube PlacementTympanoplasty (ear drum reconstruction)Otitis Externa (Swimmers Ear)

1515 N. 9th Street, Suite B
Phoenix, Arizona 85006
Located 2 blocks west of
Banner Good Samaritan Hospital
Hours: Monday-Friday
8:30am-4:30pm
Contact Us : (602) 258-9859
Fax: (602) 256-0820

Forms & Instructions

Patient Forms

Health History (first visit only)
Notice of Privacy Practices (first visit only)
Patient Demographic Record (first visit and any visit after your address, telephone or insurance has changed)
Sinus Outcome Measure Questionnaire (nasal or sinus problems only, every visit)
Nasal Endoscopy Consent Form (nasal or sinus problems only, every visit)