Forms

Pediatric Hearing Intake Paperwork

• Patient Intake Form
• Pediatric Hearing History Form
• Privacy Practice Signature Form
• Release of Information

Adult Hearing Intake Paperwork

• Patient Intake Form
• Adult Hearing History Form
• Privacy Practice Signature Form 
• Release of Information

Pediatric Speech Intake Paperwork

• Patient Intake Form
• Pediatric Speech History Form
• Privacy Practice Signature Form 
• Release of Information

Adult Speech Intake Paperwork

• Patient Intake Form
• Adult Speech History Form
• Privacy Practice Signature Form 
• Release of Information 

Patient Forms

• Accent Reduction Case History
• Adult Hearing History Form
• Augmentative Communication Evaluation Preliminary Questionnaire
• Autism Case History Form
• Adult Speech History Form
• Hearing Check List
• Patient Information Form
• Pediatric Hearing History Form
• Pediatric Speech History Form
• Privacy Practices Signature Form
• Privacy Practices Full Disclosure
• Release of Information Form
• Self Check for Adult Hearing
• Waiver of Medical Clearance for Hearing Aid Use
• WTHS Medical Clearance Form