Please click on the following links to download, print, and fill out the appropriate form prior to your appointment. 

Should you prefer we mail a paper copy to you, simply give us a call at (519) 961-9285.

Hearing Case History – To be completed prior to a hearing test appointment. Even if you have had your hearing tested in the past, we ask that you complete this form to the best of your ability. The answers you provide will give us details about your hearing and self-perceived hearing loss.

Vestibular Case History – To be completed prior to any vestibular, imbalance or dizziness testing. While some of these questions may seem repetitive, we ask that you fully complete this case history the best you can. We ask that you bring along a list of your medications, or write them in the space provided. Please note the instructions on the first page of this Case History.

BPPV Case History – To be completed prior to your BPPV evaluation. While some of these questions may seem repetitive, we ask that you fully complete this case history the best you can. We ask that you bring along a list of your medications, or write them in the space provided. Please note the instructions on the first page of this Case History.

CAP Case History – To be completed prior to your child’s scheduled CAP evaluation.

Tinnitus Case History – To be completed prior to your initial tinnitus evaluation.

Release of Information – To be completed if you have undergone testing or consultations elsewhere. This release of information allows us to obtain the results of discussed previous essential studies. Please sign the form and return to us prior to your appointment, if possible, by mail, fax or email.