M-TH 9:00 AM - 4:30 PM (Closed: Noon-1PM)Call Us410-857-3800Our Address1001 Washington Rd., Westminster, MD 21157
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FORMS

Please print and complete new patient paperwork prior to your appointment.
Patients should arrive 15 minutes prior to their appointment time.
Bring photo ID & insurance cards.
Any referrals needed must be brought to the appointment to avoid rescheduling.

Adult Hearing

If you are coming in for an Adult Hearing Evaluation, please complete the following forms:
New Patient Registration Form
Patient Agreement Form
Lifestyle Questionnaire Form
Assessment by Companion Form
Medication List

Pediatric Hearing

If your child is coming in for a Pediatric Hearing Evaluation, please complete the following forms:
Parents are required to stay with their child throughout the appointment.
If parent not attending, please send completed forms with person bringing child.
New Patient Registration Form
Patient Agreement Form
Medication List

Vertigo & Balance Testing

If you are coming in for a Vertigo & Balance Evaluation, please complete the following forms:
New Patient Registration Form
Patient Agreement Form
Lifestyle Questionnaire Form
Assessment By Companion
Medication List
VNG Instructions and Questionnaire Form

Miscellaneous

HIPPA Information Form
Records Release Form