Patient Information

New Patient Forms

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

Appointment Policies

At Northwest Speech and Hearing Center, we understand that life can get busy and schedules can change unexpectedly. Our goal is to make sure every patient — children, adults, and families — has the opportunity to receive the care they need.

To help us serve everyone fairly, we ask that you please review our appointment policy below.

If You Need to Cancel or Reschedule

We kindly ask for at least 48 hours’ notice if you need to cancel or move your appointment.

• Cancellations made with less than 48 hours’ notice may be subject to a late cancellation fee of $150.
• Frequent late cancellations may make it harder for us to offer your preferred appointment times.

If You Miss an Appointment (No-Show)

When a patient doesn’t arrive for a scheduled appointment and we haven’t received notice, that time is reserved and can’t be offered to another patient.

• Missed appointments without notice may result in not receiving the deposit back.
• After two (2) missed appointments, we may ask that future visits be confirmed or prepaid.

If you need to cancel or reschedule, please let us know as soon as possible:

• Call 847-392-2250
• Email moc.gniraehwn@ofni