Patient Information Center

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:

 New Patient Forms

• New Patient Letter
• Patient Information Pack
  
• Fee and Payment Information
• Release of Medical Records Authorization
• CT Scan Request Form

Downloadable Directions

• Portola Valley Office Directions

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. Portola Valley, CA 94303
or email to: atresiarepair@calear.com