Forms

  • Hearing Health Report (Adult)

For patients 18+ years old

To reduce your waiting 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 less than 18 years old

To reduce your waiting 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



  • 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



  • 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. Click to Continue >>


 

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