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

• Hearing Health Report (Pediatric)

For patients under 18 years old

Spanish Version – Reporte de Salud Auditiva Pediátrico

• Tinnitus Assessment Inventories

Spanish Version – Cuestionario de Reacción al Zumbido

• Hearing Handicap Inventory for Adults (HHIA)

• Vestibular Testing Intake Form

• Release of Patient Information Form

• Acknowledgment of Notice of Privacy Practices

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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