Patient Forms
New Patient Forms
Save time at your appointment — download, print, and complete your forms before you arrive.
We Welcome New Patients
Please download and print the forms below before your first visit. Complete them at home at your own pace and bring the printed copies to your appointment.
Forms cannot be submitted online. Please bring completed printed copies to your appointment.
- Open PDF
Patient Information Form
General intake information — name, address, insurance, emergency contact, and referring provider.
- Open PDF
Case History Form
Your hearing history, current concerns, and any prior hearing aid experience. Helps us prepare for your appointment.
- Open PDF
HIPAA Consent Form
Privacy notice acknowledgment and authorization for the use of your health information.
- Open PDF
Self-Assessment Questionnaire
Rate how much difficulty you experience in everyday listening situations. Guides your initial evaluation.
- Open PDF
Tinnitus Questionnaire (THI)
The Tinnitus Handicap Inventory — for patients experiencing ringing, buzzing, or other tinnitus symptoms.
Questions Before Your Visit?
Our team is happy to answer any questions about your upcoming appointment or what to expect.