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.

All Patients: HIPAA Policy for your review, no need to print.

HIPAA Policy

All New Patients: Please fill out the following forms.

  • Patient Information Form
  • Hearing Health Questionnaire
Patient Information Form
Hearing Health Questionnaire

All New Medicare Patients: Please fill out the following forms. 

  • Patient Information Form
  • Hearing Health Questionnaire
  • Medication Form
Patient Information Form
Hearing Health Questionnaire
Medication Form

All New Tinnitus Evaluation Patients: Please fill out the following forms.

  • Patient Information Form
  • Hearing Health Questionnaire
  • Tinnitus Program Outline
  • Tinnitus Questionnaire
  • Depression Inventory
Patient Information Form
Hearing Health Questionnaire
Tinnitus Program Outline
Tinnitus Questionnaire
Depression Inventory

Ready to regain control of your hearing?

Our hearing professionals are eager to help you embark on a journey towards better hearing.
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