Patient Forms
To get the most out of your better-hearing consultation, please fill out these forms and print them to bring with you to your appointment.
We encourage you to fill out your paperwork prior to your appointment — it can help save you time when you check in to our office, spur important conversations between you and your loved ones, and get you thinking about your better-hearing goals.
To fill out your patient form prior to your appointment, click the link to download the form(s) you need.
English
Adult Hearing Patients
Hearing Health Assessment
Patient Registration
Authorization Disclosure
Release of Records
Child Hearing Patients
Child Hearing Questionnaire
Infant Hearing Questionnaire
Patient Registration
Authorization Disclosure
Release of Records
Tinnitus Patients
Tinnitus and Hearing Survey
SMRT Form
Hearing Health Assessment
Patient Registration
Authorization Disclosure
Release of Records
Tinnitus Handicap Inventory
PHQ-9
Equilibrium / Balance Testing
Hearing Equilibrium Questionnaire
VNG Test Prep Instructions
Patient Registration
Authorization Disclosure
Release of Records
Spanish
The Following is Only Required if Instructed by Staff.
Forma de liberacion
Informacion del paciente
Paciente Autorizacion de Divulgacion/correo electronico o fax
Al oir equilibrio Cuestionario
Instrucciones de VNG Test Prep