Forms

  • Hearing Health Report (Adult)

For patients 18+ years old

To make the best use of your time at your first appointment, please complete the form in advance. Email the completed PDF to care@HearingDoctors.com, or bring a printed copy to your appointment. Open Adult HHR Form

Spanish Version – Reporte de Salud Auditiva

Abre el formulario 1) Guardalo en tu computadora. 2) Completalo. 3) Imprímelo y tráigalo a su cita o adjunta al correo electrónico a: care@HearingDoctors.com.
  • Hearing Health Report (Pediatric)

For patients 18+ years old

To make the best use of your time at your first appointment, please complete the form in advance. Email the completed PDF to care@HearingDoctors.com, or bring a printed copy to your appointment. Open Pediatric HHR Form.

Spanish Version – Reporte de Salud Auditiva Pediátrico

Abre el formulario, imprímelo, completarlo y tráigalo a su cita.
  • Tinnitus Assessment Inventories
Do you have ringing in your ears? These questionnaires are designed to find out what sort of effects tinnitus has had on your lifestyle, general well-being, etc. Please download the file, complete the questionnaires, and bring a printed copy with you to your appointment. Download File

Spanish Version – Cuestionario de Reacción al Zumbido

Abre el formulario, imprímelo, completarlo y tráigalo a su cita.
  • Hearing Handicap Inventory for Adults (HHIA)
This inventory provides us with a better understanding of the impacts and difficulties faced due to hearing loss. Download Form
  • Vestibular Testing Intake Form
Completing this form prior to your vestibular testing appointment allows us to better understand your symptoms and your struggles. Download Form
  • Release of Patient Information Form
In some cases we require additional information from your Primary Care Physician and/or your Ear, Nose & Throat (ENT) Doctor in order to provide the best possible care for you. This form requests information to be sent from your doctor to Hearing Doctors.Download Form

The Health Insurance Portability and Accountability Act (HIPAA) requires us to provide patients or their power of attorney (POA) with our Notice of Privacy Practices, and to obtain their signature to acknowledge that they have received it. Providing your digital signature takes approximately 1 minute and doesn’t require any special software.

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Our
Experience

Audiology & Balance Experts Providing Exceptional Care For Your Quality of Life

Cutting-Edge Technology

State-of-the-Art Equipment Ensuring Accuracy, Best Fit & Superior Sound Quality

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We Accept Most Insurances

We Process Your Claims Get Maximum Benefits Pay Less Out of Pocket

Patient Testimonials

McLean, VA...........(703) 962-6139
Cascades, VA.....(703) 722-8222
Falls Church, VA...(703) 485-4531
Fairfax, VA............(571) 295-5613
Rockville, MD........(301) 761-2988
Falcons Landing....(703) 722-8175
Silver Spring..........(301) 761-4758
Toll Free.................(703) 822-7328

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