Patient Forms

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Patient Profile and Consent
This form needs to be filled out, and signed, for all new patients prior to their appointment.

Release of Medical Information
Document that needs to be signed and delivered by fax, in person, e-mail, or by snail mail to release medical records.

Listening and Communication Strategies
These are critical tips to help facilitate successful communication for persons with hearing loss.

Tips for Communicating With Persons with Hearing Impairment
These are critical points to utilize when conversing with persons who suffer from hearing loss.

Infant Hearing Alert
Language and development guidelines for parents who suspect their child is experiencing hearing loss.

Vestibular Balance Test Instructions
Directions to follow 48 hours before Electronystagmography balance testing (ENG).

Vertigo Questionnaire
Questionnaire that needs to be filled out before Electronystagmography balance testing (ENG).

Canalith Repositioning Procedure
Defines treatment for Benign Paroxysmal Positional Vertigo (BPPV).

Post Canalith Repositioning Precautions
Precautions to follow after Benign Paroxysmal Positional Vertigo (BPPV) treatment.

Cawthorne Balance Exercises
Physical therapy exercises to follow for one month after being diagnosed with
Vestibular Neuronitis