Forms related to CDH

Unsurprisingly, we have quite a few forms.

Questionnaires for first visits to any of our doctors:

• Online questionnaire (preferred for all )
• Paper questionnaires (not so enthusiastic but we will deal with it)
  • If you have mainly dizziness or a hearing problem, except for tinnitus, please fill out the dizzy questionnaire (pdf format).
  • If you mainly have tinnitus, use the tinnitus questionnaire.
  • If you have mainly headaches, please fill out the headache questionnaire (pdf format).
  • If you have something other than dizziness or headaches, please fill out the neurology questionnaire (pdf format).

Release forms: (optional)

• medical release "to" form (pdf format) and send it to your doctor
• medical release "from" form. If you would like us to send records to someone else, bring it with you or mail it to us.

Consent forms -- most are optional (pdf format)

(We will ask you to sign to acknowledge that you read and consent at the time of your first visit. Copies are also available in the office)

• Information about diagnostic ear procedures (no signature needed)
• Consent for research (optional)
• Consent for telehealth (this is online) (required once for telehealth visits)

Legal disclosures and consent to care (pdf format) -- this is the fine print.

• Privacy practices
• Financial Policies

More information about what to expect at your visit can be found at the Appointment page.