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Patient Forms

Click on a form or handout below to view, download and print. You can download all intake forms at once at the link below.


By filling out these forms prior to your appointment, valuable time will be saved during your visit.  If you prefer to fill up the forms in our office, please arrive about 10-15 minutes prior to your scheduled appointment.

Dr. Mimi's Audiology Clinic - Patient Forms and Handouts


New Patient Form
Current Medication List
Practice Consent Form.jpg
Payment Agreement 2023 thumbnail.jpg
Appointment Reservation Policy & Agreement


Personal Impact of Untreated Hearing Loss
Effective Communication Strategies for Hard of Hearing People


Tinnitus Handicap Questionnaire
Tinnitus Reaction Questionnaire
Image by Sergey Shmidt

"Love is like wildflowers; it’s often found in the most unlikely places."


- Ralph Waldo Emerson

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