Please Print and Complete the Following Forms
- Adult Questionnaire OR Pediatric/Adolescent Questionnaire
- HIPAA/Patient Acknowledgment of Privacy Practices
- If your visit is related to dizziness, balance, or vertigo, please print this form.
- If your visit is related to snoring concerns, please print this form.
Please Review the Following Form (No Need to Print)
Please Arrive 10-15 Minutes Early and Bring the Following
- Your insurance card(s)
- A photo id
- Referral (if required by your insurance carrier)
- Co-pay (if required by your insurance carrier)
We accept cash, check, and all major credit cards.
For established patients returning for special testing
- Allergy testing: Instructions/Consent and History form
- Instructions for VNG (balance/dizziness evaluation)
If you have been seen at an outside facility which has records pertinent to your condition
- Please complete this request form. You may send it to the office to handle the request or submit directly to the outside facility.