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.
New Patient Forms
Please fill out the forms below and bring them into the appointment with you.
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.
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.
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.
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.
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.
Dr. Johnson was amazing. I had no idea what I was really missing until she had me try out some hearing aids. My wife and kids were telling me “Dad, get your ears checked”…
Dr. Johnson was amazing. I had no idea what I was really missing until she had me try out some hearing aids. My wife and kids were telling me “Dad, get your ears checked” consistently and I was like “I will… I will…” Dr. Johnson and Windsor Audiology changed my life. I can hear the crack of the bat when my daughter hits a home run. That is life-changing.
Dr. Johnson’s smile is very warming. When I walk in the door, no matter what kind of mood I am in, she always makes me smile and changes my mood around. My time with Dr. Johnson…
Dr. Johnson’s smile is very warming. When I walk in the door, no matter what kind of mood I am in, she always makes me smile and changes my mood around. My time with Dr. Johnson is special and she makes me feel like I am her only concern.
I am glad I found Dr. Johnson. She listened to my concerns and has some great solutions to help me with my hearing loss.
"I am writing to thank you for your patience and expertise in finding me the right hearing solutions. You took great care in testing for my needs and after your research and a…
"I am writing to thank you for your patience and expertise in finding me the right hearing solutions. You took great care in testing for my needs and after your research and a trial period, you found the perfect hearing aids to match my situation. Also, your office has always been very prompt and professional when I call with a question or to make an appointment. Finally, your coffee is tops...why do you think I always arrive a little early!"
Windsor Audiology has provided me with the best possible care. From Evan at the front desk to Leann and her ability to explain the entire hearing assistance process. She helped…
Windsor Audiology has provided me with the best possible care. From Evan at the front desk to Leann and her ability to explain the entire hearing assistance process. She helped ease my apprehension about the process and made it very easy to commit to hearing aids. I barely notice my tinnitus anymore! I am very happy with my decision and experience. Thank you Evan and Leann!
I came in to see Dr Johnson and her staff about 5 months ago. I had crippling Tinnitus, so much so that it was causing depression and insomnia. It was a constant buzzing of a…
I came in to see Dr Johnson and her staff about 5 months ago. I had crippling Tinnitus, so much so that it was causing depression and insomnia. It was a constant buzzing of a mosquito in my ears and I had come to believe that I was stuck with this unwanted “friend” for the rest of my life. I looked up Tinnitus treatments for Northern Colorado and Windsor Audiology came up. I figured it couldn’t hurt to try. After my initial consultation and test with Dr Johnson we settled on trying hearing aids with a Zen Tinnitus therapy. I was extremely skeptical about the process, but again it was worth a try. It has been 5 months with my hearing aids and, I use the Zen therapy regularly. In the last 5 months I used to wake up almost nightly from the Tinnitus, now it has only happened once in 5 months. I HIGHLY recommend Dr Jonson and Windsor Audiology. Dr. Johnson and Evan are extremely knowledgeable and truly care for their patients. If you have Tinnitus, hearing problems or both, go see them. They are amazing!
Their willingness to help my hearing loss and listening to my personal issues at home and TV volume corrections was exceptional.
Dr. Johnson is easy to talk to, answered all of my questions and was very professional.
Dr. Johnson took the time to work with my specialty hearing issues.
They have a pleasant atmosphere and all of my questions were answered