Download Patient Forms Here (PDF format*)

Please note: When you click on a link below, it will open a tab with only that link on it.  Click the link a second time and the form will open in a separate tab.  (NOTE:  With Firefox web browser, the form will be downloaded to your download arrow icon on the Firefox toolbar, which will turn blue.  Click the arrow, then the file name to open it.)

Download Patient Office Forms Below:

EARC Pediatric Intake Form

EARC Adult Intake Form

EARC- Medication List

EARC- HIPAA Privacy Practices

EARC- PHI Contact Permission Form

EAR-C Records Release-TO us

Download Patient Questionnaires Below:

Fisher’s Auditory Problems Checklist

Buffalo Model (BMQ-R) Questionnaire

*If you don’t have the free Adobe PDF Reader, download it here. (NOTE: Uncheck any box for unwanted optional products [which may appear in Adobe’s link from time to time] BEFORE clicking the “INSTALL NOW” link.)

If  you prefer to download the forms in Microsoft Word Document format (.doc), please email us at and we will send them to you. 

If you have questions or difficulties, please call us at