New Patient Forms

Below are our Patient Health History, Perception of Hearing by a 3rd Party, and our HIPAA Wax Waiver Forms.

Please fill out the forms, print and bring with you to your appointment.

If you have any questions about the forms, please contact us at 303.499.3900.

 

2016 Patient Health History Form

 

Use this form to tell us about your Health History.

To Download the form, Click here, or click the image on the right.

 

Perception of Hearing By A 3rd Party (Spouse, Friend, Family Member) Form

 

Use this form to tell us about your Hearing. You will need a Spouse, Friend or Family Member to help you.

To Download the form, Click here, or click the image on the right.

 

HIPAA-Wax Waiver Form

 

This is the Standard HIPAA Compliance Form. The Wax Waiver part of this form will authorize us to remove Cerumen (ear wax) from your ears.

To Download the form, Click here, or click the image on the right.