Patient intake forms collect the personal, medical, and insurance information we need to provide you with the best possible care. You can complete them in the office before your first visit, or fill them out in advance using one of the options below. Either way works.
What to Bring to Your First Visit
- Photo ID (driver’s license or other government-issued ID)
- Insurance card (front and back)
- Referring physician name and contact information, if applicable
- List of current medications — some can affect hearing
- Any previous hearing test results if you’ve been tested before
- Existing hearing aids if you have them — we can evaluate them as part of your visit
- A family member or friend if it would help — spouses and adult children often catch important details and support adjustment
Filling Out Forms in Advance
1. Book your appointment
Schedule your visit through our online booking portal or call us at (954) 999-5495. Once your appointment is confirmed, your information is added to our patient management system.
2. We send your forms to you electronically
You’ll receive an email from our office with a secure link to complete your intake forms online before your visit. This is the fastest and most convenient way to handle paperwork — no printing, no scanning, and no juggling paper at check-in.
The forms you’ll receive typically include:
- Patient demographics and contact information
- Medical history and hearing concerns
- HIPAA acknowledgment and communication preferences
- Insurance information (if applicable)
The full intake usually takes 10–15 minutes. You can complete it on your phone, tablet, or computer at your convenience — pause and resume as needed.
3. Prefer to fill them out in person?
If you’d rather complete the forms at the office, just arrive about 15 minutes before your appointment. Our front-desk team will provide the forms on paper and help with any questions. There’s no penalty for completing forms in person — we just want to make sure your appointment time goes to your hearing evaluation, not paperwork.
HIPAA & Privacy
All patient information you provide is handled in accordance with HIPAA regulations and our privacy practices. Your information is used solely for your care and is never sold or shared outside of authorized clinical and administrative purposes.
See our privacy policy and our Notice of Privacy Practices (HIPAA-required) for full details. The Notice of Privacy Practices is also available as a PDF.
Insurance Verification
We work with most major insurance plans. If you’d like us to verify your specific benefits before your visit so you know exactly what to expect, just call our office at (954) 999-5495 with your insurance information. We typically have an answer within one business day.