Patient Paperwork

Patient Paperwork may be emailed or mailed to you prior to your appointment, or you can print off your specific packet below (click on PDF). Remember to bring the completed forms with you for a timely check-in process. View our HIPAA Privacy Notice (PDF)

ADULT New Patient Paperwork (PDF) includes:

• Intake Form
• Adult Case History
• Financial Policy

CHILD 3 YEARS & YOUNGER New Patient Paperwork (PDF) includes:

• Intake Form
• Pediatric Case History
• EHDI Form
• Financial Policy

CHILD 4 YEARS & OLDER New Patient Paperwork (PDF) includes:

• Intake Form
• Pediatric Case History
• Financial Policy

ADULT CASE HISTORY FORM (PDF)

INDUSTRIAL QUESTIONNAIRE (PDF)

Timing Your Appointment

Thank you for choosing Constance Brown Hearing Center for your hearing healthcare needs.

During the pandemic, we ask that you come only 5 minutes before your appointment and please limit the number of people coming with you to your appointment. To ensure an efficient visit to Constance Brown Hearing Centers, please allow yourself time to arrive 15 minutes prior to your scheduled appointment.  Appointments are made according to the amount of time the staff anticipates that each patient will need.

Arriving extremely early may cause an extended wait time as other patients will be seen at their scheduled appointment times first.  If you arrive late, we will make every effort to see you but you may be asked to reschedule.