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Downloadable PDF files:

New Patient Forms

Billing Information Sheet
Health Information Release
Hearing History-Adult
Hearing History-Child

Cochlear Patient Forms

Hearing Handicap Inventory Prior to Cochlear Implantation
IT - MAIS
Teachers Questionaire

Vestibular Patient Forms

Tinnitus Patient Forms

Tinnitus Impact Assessment
Tinnitus Handicap

Student Forms

Parent Infant Program Registration 2008 - 2009
Audiological Release 2008 - 2009
HHLA Registration 2008 - 2009

Copyright 2009 The Heuser Hearing Institute
117 E. Kentucky Street Louisville, KY 40203
info@thehearinginstitute.org • Phone: V - 502.515.3320 or TDD - 502.515.3323 • Fax: 502.515.3325
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