Patient Information
Welcome to our patient information center, below is our patient information pack. Please download, print and complete. To have Dr. Roberson review your CTs for Atresia repair candidacy, please fill out the Atresia Intake Sheet form below and send it, along with the CT (CDs preferred) and most recent audiogram to:
Patient Information Pack
Atresia Intake Sheet
This paperwork only needs to be filled out if you are coming to see Dr. Roberson for an in-person consultation, or if you have already had a remote consultation with him and wish to schedule surgery. Please return the forms either by fax to (650) 462-3164 or by regular mail to:
International Center for Atresia and Microtia Reconstruction
California Ear Institute
Attention: New Patient Demographic Forms
1900 University Avenue, Suite 101
E. Palo Alto, CA 94303
or email to: 
Forms Require Free Adobe Reader Software - download here if needed

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