You may download the forms relevant to your situation below. Please email your completed forms at least 3 days prior to your appointment to [email protected]
Hearing Loss (Adult)
Hearing Loss (Child)
Tinnitus and Hyperacusis (Adult)
- Adult Personal Information
- Adult Case History
- Tinnitus Handicap Inventory
- Tinnitus and Hyperacusis Questionnaire
Tinnitus and Hyperacusis (Child)
- Child’s Personal Information
- Tinnitus Handicap Inventory
- Child’s Case History Form
- Tinnitus and Hyperacusis Questionnaire
CAPD (Adult)
- Adult Personal Information
- Adult Case History
- Central Auditory Processing Questionnaire
- Observation of auditory processing skills
CAPD (Child)
- Child’s Personal Information
- Child’s Case History Form
- Parents Observations of Childs Auditory Processing Skills
- Child’s Central Auditory Processing Disorder Questionnaire
Custom Ear Plugs