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Medical Forms For Your Hearing Appointment

Hearing History Case History Form

To provide the best care that we can, a thorough medical history is necessary. Please fill out the Hearing History Case History Form (PDF) and bring it with you to your appointment. You may also fill this out when you arrive at your appointment (if so, please arrive 15 minutes early for paperwork).

Adult Case History Pediatric Case History

Self-Assessment of Communication Form

If you feel that you are having hearing difficulties please fill out a short 9 question Self-Assessment of Communication Form (PDF) and bring it to your appointment. You may also fill this out when you arrive at your appointment (if so, please arrive 15 minutes early for paperwork).

Click here to view the form