Patient Forms

Please download, print, and complete the forms relevant to you visit. If you are unsure of which forms apply to you appointment, feel free to call our front desk at 206-320-5687.

Patient Information

Adult Hearing History

Pediatric Hearing History

Tinnitus Questionnaire

Dizziness/Imbalance Questionnaire

Financial Agreement

Privacy Policy


Which Forms Should I Fill Out? 

Below is a list of forms required for each appointment type. If you still have questions on which forms you need to fill out for your appointment, please call (206) 320-5687. 

Pediatric Hearing Evaluation: 

  • Patient Information 
  • Pediatric Hearing History
  • Financial Agreement
  • Privacy Policy

Hearing Evaluation:

  • Patient Information
  • Adult Hearing History
  • Financial Agreement
  • Privacy Policy

Dizziness/Imbalance Testing:

  • Patient Information
  • Adult Hearing History
  • Financial Agreement
  • Privacy Policy 
  • Dizziness/Imbalance Questionnaire

Tinnitus Consult: 

  • Patient Information
  • Adult Hearing History
  • Financial Agreement
  • Privacy Policy
  • Tinntius