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


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