Patient Intake Forms

General Patient Forms

• Patient Information
• Case History
• Authorization of Disclosure
• HIPAA

Tinnitus Forms

• Patient Information
• Tinnitus Functional Index
• Tinnitus History Questionnaire
• Tinnitus Reaction Questionnaire
• Anxiety & Depression Screening

Hyperacusis Forms

• Patient Information
• Sound Sensitivity Questionnaire
• Hyperacusis Assessment Questionnaire
• Anxiety & Depression Screening

Misophonia Forms

• Patient Information
• Sound Sensitivity Questionnaire
• Misophonia/Hyperacusis Assessment Questionnaire
• Anxiety & Depression Screening