Clinic Forms
When you schedule an appointment or consultation, you will be asked to fill out various forms prior to being seen in our clinic. Please print out the various forms, and complete them prior to your appointment. If you have any questions or need help with the forms, please feel free to contact our Office Manager and she will be happy to assist you. Got questions but too busy to call us? Email us at [email protected]. We will respond as quickly as possible. Thank you.
Tinnitus Patients
- Tinnitus TRQ
- Tinnitus History Questionnaire
- Tinnitus Handicap Inventory
- Notice of Privacy Policy (HIPPA)
- Patient Information
- Medical History
- TFI-Tinnitus Functional Index
- Authorization for Release of Medical Records
Misophonia Patients
- Misophonia History Questionnaire
- Misophonia Assessment Questionnaire
- Notice of Privacy Policy (HIPPA)
- Patient Information
- Medical History
- Authorization for Release of Medical Records