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
Option 1: Online intake (after appointment booking)
When you schedule a visit through our online scheduler, you’ll receive an email with a secure link to complete your intake forms electronically before your appointment. This is the fastest and most convenient option once your appointment is confirmed.
Option 2: Download and print
If you prefer to fill out forms by hand, you can download the relevant PDFs below. Print, fill out, and bring them with you to your first visit. (PDF downloads will be added here once the new intake forms are finalized. In the meantime, please call us if you’d like the forms emailed to you.)
- Patient Intake Form — PDF coming soon
- Medical History Form — PDF coming soon
- HIPAA Acknowledgment — PDF coming soon
- Insurance Authorization — PDF coming soon
Option 3: Complete in office
If you’d rather fill everything out at your visit, plan to arrive 15 minutes before your appointment time. Our front-desk team will provide the forms and help with any questions.
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 for full details.
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.