Forms

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This form is for individuals over the age of 18, coming to the clinic for a routine or comprehensive hearing evaluation. 

This form is not for veterans being sent to us through a third party scheduler, with the exception of the VA Community Care Network.  For veteran exit exams, please see a different link below.

This form is for patients under the age of 18 coming in for a hearing screening or comprehensive diagnostics.  PLEASE NOTE: If your child is under 3 years of age, it is important that you schedule the appointment during a nap time.  We do not do sedated testing and they will need to be able to sit or lay quietly.

These forms are a separate set of forms that should be completed if you are experiencing ringing in your ears and would like to discuss treatment options during your visit.  

If you are completing these forms, you still need to complete the pediatric or adult hearing form.  

This form is for individuals under the age of 18, coming to the clinic for a comprehensive speech-language evaluation.

This form is not for adults or individuals who need a swallow test.

This is for individuals 18 years of age and older, coming to the clinic for a comprehensive speech-language evaluation.

This form is not for individuals who need a swallow test.

If you plan to receive services through one of our telehealth options, this form is needed.  

This form is to be completed in addition to the other form(s) you need.