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Northwest Speech and Hearing Center

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    • Our Services
    • Pediatric Hearing Evaluations
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  • Lenire for Tinnitus
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  • 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

Essential Patient Forms for Your Hearing Care AppointmentPatient 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

 

Additional Patient Forms for Your Hearing Appointment

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

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

Contact Us

Call: (847) 392-2250

Text: (618) 414-9992

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Looking for Tinnitus Relief? Learn About Lenire!

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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

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Importance of Completing Patient Forms

Completing patient forms prior to your appointment is crucial for ensuring a smooth and efficient visit. These forms provide the healthcare team with essential information about your medical history, current medications, and specific concerns, enabling them to tailor their services to your needs.

By filling out these forms in advance, you help minimize wait times and streamline the check-in process. This preparation allows the audiologists and staff at Northwest Speech and Hearing Center to focus more on your hearing health rather than administrative tasks during your visit.

How to Access and Download Forms

Accessing and downloading the necessary patient forms is a straightforward process. Visit the designated section on our website, where you will find links to each form needed for new patients, including the Patient Intake Form and Hearing History Form.

Once you click on the links, the forms will open in a PDF format, allowing you to print them directly or save them to your device for later completion. Ensure that you have the latest version of Adobe Reader or another PDF viewer to facilitate this process smoothly.

Frequently Asked Questions About Patient Forms

Many new patients have questions regarding the completion of their forms. Common inquiries include what information is required, how long it takes to fill them out, and whether they can submit them electronically. Understanding these aspects can alleviate concerns and encourage timely completion.

For example, most forms can be completed in under 15 minutes, and they typically require basic personal information and details about your hearing health. If you have any questions while filling out the forms, our staff is available to assist you via phone or email.

Next Steps After Form Submission

After you have completed and submitted your patient forms, the next step is to prepare for your appointment. You will receive a confirmation email with details about your visit, including the date, time, and any additional instructions you may need to follow.

It's also a good idea to review the forms you submitted and ensure you bring any relevant documents, such as insurance cards or referral letters, to your appointment. Being fully prepared will help maximize the effectiveness of your consultation at Northwest Speech and Hearing Center.