Clinic Forms

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, Morgan, and she will be happy to assist you.  Thank you.

Tinnitus Patients
Tinnitus TRQ
Tinnitus History Questionnaire
Tinnitus Handicap Inventory
Notice of Privacy Policy (HIPPA)
Patient Information
Medical History
Patient Information
TFI-Tinnitus Functional Index

Patients Without Tinnitus
Notice of Privacy Policy (HIPPA)
Patient Information
Medical History