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New Patient Forms

Prior to your appointment, the clinic administrative staff will contact you and ask you to download and complete one or more of the following forms.

Notices of Nondiscrimination 

Hearing Clinic Notice of Nondiscrimination
USF Health Notice of Nondiscrimination and Accessibility Requirements

 Forms for Pediatric Patients

Newborn Case History (0 - 3 months)
Newborn Case History (0 - 3 months) - Spanish
Infant Case History (3 - 6 months)
Infant Case History (3 - 6 months) - Spanish
Pediatric Case History (6 months - 17 years) 
Pediatric Case History (6 months - 17 years) - Spanish
Pediatric APD Case History (K - 5th grade)
Pediatric APD Case History (K - 5th grade) - Spanish
Pediatric APD Case History (middle & high school)
Pediatric APD Case History (middle & high school) - Spanish

Forms for Adult Patients

Adult Case History 
Adult Case History - Spanish
Balance Assessment Case History
Balance Assessment Case History - Spanish
Cochlear Implant Supplemental Case History
Cochlear Implant Supplemental Case History - Spanish