Registration Forms

If you are planning to visit our office for medical or audiological services, you may download and print copies of forms which will expedite your patient registration. 

Please fill out the forms as completely as possible and bring them with you 20 minutes prior to your scheduled appointment. The forms are available in portable document format (pdf). 

NOTE: You will need Adobe Acrobat Reader to view and print these forms. Acrobat Reader can be obtained free of charge at www.adobe.com/products/acrobat/readermain.html

The forms you need to complete and bring with you are:

1. Patient Information (regform1.pdf)
2. Notice of Health Information Practices (regform2.pdf)
3. Patient Financial Policy (regform3.pdf)

Additional forms related to hearing loss are also available:

• Hearing loss questionnaire (hearing.pdf)
• Dizziness questionnaire (dizziness.pdf)

Please take the time to read and understand these forms. If you have any questions, let us know when you are registering. Please bring any medical records pertaining to your visit, along with your insurance cards and a valid driver license.