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New Patient Intake Forms

Here you’ll find our patient forms, such as a new patient intake sheet — our standard office paperwork.
We understand your time is valuable and that sitting in the doctor’s office completing paper work is the last thing you want to do, so we have 3 ways for you to complete your paperwork. You may download and complete our forms below, you can arrive to your appointment 15 minutes early and complete them in our office, or you can click the button that says Patient Portal create an account and complete them all on line! Having your paperwork completed prior to your visit helps us make sure that your time with us is thoughtful and prompt.

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New Patient Forms

Please fill out the forms below and bring them into the appointment with you.

Medical History and Hearing Health Questionnaire

We are considered a medical practice and have to have this information on file by law. If you have a list of prescriptions please feel free to bring the list in with you and our staff with copy it to your file so you do not have to write them all down.

Protected Health Information Release

This is the form that gives us permission to tell people about you. We will NEVER release information to anyone that is NOT on this form…even if your spouse calls and asks if your hearing aids are back from repair. If their name is not on this form, we will not tell them either way! We take this form VERY seriously so please make sure you list all individual people that you would like to have access to your hearing healthcare information on this form. It will also give us a few other permissions so please make sure that you answer all of the questions and sign at the bottom.

New Patient Information

Here is all of your basic information. This form includes your contact information and HIPAA signature. Please make sure fill out all of the highlighted information at the very least and to list a primary care physician. If you are on Medicare or Medicare Complete, please also call your physician to obtain a Referral this is required. You may have them fax it to 970-631-8869. If you would like to print a copy of our HIPAA statement for your personal records you may print it out here.

Tinnitus Questionnaire

This form is for our Tinnitus Evaluation Patients only! Please make sure to answer as many of the questions as you can and make sure to be as honest and as forthcoming as possible.

Financial Policy

Please read the full Financial Policy for Windsor Audiology. A signature is required.

Questions About Our Forms?

If you have any questions or concerns regarding the paperwork please feel free to contact us here or by phone. Thank you for choosing Windsor Audiology in Northern Colorado for your hearing needs! Your hearing journey begins with us.

Clinic Reviews

We look forward to helping you on your hearing healthcare journey!