Northwest Speech and Hearing Center

Northwest Speech and Hearing Center

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  • About
  • Services
  • Services
    • Our Services
    • Pediatric Hearing Evaluations
    • Testimonials
  • Lenire for Tinnitus
  • Resources
  • Resources
    • Tinnitus
    • Starting The Conversation
    • Hearing Loss Prevention Tips
    • Hearing Devices
    • Patient Forms
    • Payment and Insurance
    • FAQs
  • Pay Bill Online
  • Book Appointment
  • Contact
  • Call (847) 392-2250
  • Home
  • About
  • Services
  • Services
    • Our Services
    • Pediatric Hearing Evaluations
    • Testimonials
  • Lenire for Tinnitus
  • Resources
  • Resources
    • Tinnitus
    • Starting The Conversation
    • Hearing Loss Prevention Tips
    • Hearing Devices
    • Patient Forms
    • Payment and Insurance
    • FAQs
  • Pay Bill Online
  • Book Appointment
  • Contact
  • Call (847) 392-2250

Patient Forms


Forms for New Patients: Prepare for Your Appointment

Here are the new patient forms for you to download, complete, and bring to your scheduled visit. Our audiologists and team are excited to meet you!

Patient Intake Form


Hearing History Form


Pediatric History Form


Vestibular Case History Form


Tinnitus Function Form


Tinnitus Handicap Inventory Form

 

Other Patient Forms

Release of Information Form

Improve your life by scheduling an appointment today!

At Northwest Speech and Hearing Center, we offer personalized hearing care. Take charge of your hearing health now!

Schedule an Appointment

Visit Us

1100 W Central Rd, Suite 409
Arlington Heights, IL 60005

Contact Us

Call: (847) 392-2250

Text: (618) 414-9992

Get Directions

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Looking for Tinnitus Relief? Learn About Lenire!

Lenire is a treatment device proven to reduce the severity of tinnitus that can be used from the comfort of your home. Click below to learn more and request an appointment!

Learn about Lenire