NEW PATIENT FORMS
Thank you for choosing East Valley Hearing Center for your patients’ hearing healthcare needs.
When we see patients for the first time, we ask them to bring their spouse, family member, friend or anyone with whom they communicate with most often. We have found companions provide emotional support and learn useful techniques from the audiologist to ensure effective communication.
We also ask new patients and their companions to complete appropriate forms prior to the appointment. These forms provide the audiologists with a complete medical and hearing history needed for a more accurate assessment of the patient’s hearing health. If you have any questions about any of the information included in this packet, please feel free to contact our office
The following are our downloadable forms included in our New Patient Packet:
- BPPV History – to be completed by patients who are experiencing dizziness.
- Cerumen Management History – to be completed by patients experiencing excessive cerumen.
- Companion Questionnaire – to be completed by a spouse or companion who is familiar with your hearing issues.
- Hearing Health Assessment – to be completed by all patients.
- Patient Registration – to be completed by all patients.
- Pediatric Case History – to be completed by parent or guardian of a minor patient.
- Tinnitus Handicap Inventory – to be completed by patients who are experiencing tinnitus.
- HIPAA 2017