New Audiology Patients

If you’re a new patient, or a physician referring a patient, the documents on this page will be helpful.

New Patient Info Forms

Prior to your first appointment, it will be helpful and will save you time in our waiting room if you will print, fill out, and bring with you the applicable new patient information form (either Adult or Child Client Info).

Adult Client Info

Information we’ll need for an Adult client

Child Client Info

Information we’ll need for a Child client

ABR – Instructions for Parents

Instructions for parents whose child will be having an Auditory Brainstem Response (ABR) test, during which the child must sleep

Privacy of Your Health Information

We respect your right to privacy of your health information, and we will protect any information we receive or contribute. The following forms are related to this.

Notice of Privacy Practices

An explanation of your rights to privacy of your health information

Acknowledgement of Receipt of Notice of Privacy Practices

A form acknowledging that you’ve received our Notice of Privacy Practices explanation

Authorization for Release of Medical Information

A form enabling us to receive from and/or forward information back to your physician

Referring Physicians

We have a short form that allows a physician to refer a patient to us.

Referral Form

A short form that a physician may use to refer a patient to us

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