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

Auditory Processing Forms

If you or your child is coming in for an Auditory Processing Evaluation, please complete the following forms:

New Patient Registration Form

Patient Agreement Form

Medication List

Auditory Checklist Form

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