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WE ARE RE-OPENING OUR CENTERS.

Following guidelines of local, state and federal health officials, the CDC and the WHO, we have begun re-opening our hearing centers. However, the health of our patients, hearing care professionals and associates remains our top priority. For more information and a list of the locations that are open, click here.

Form

HIPAA Form
Premier Hearing Center

HIPAA Form

Categories: Form
Hearing Inventory Form
Premier Hearing Center

Hearing Inventory Form

Categories: Form
Patient Demographic Information
Premier Hearing Center

Patient Intake Form

Categories: Form
Tinnitus Functional Index
Premier Hearing Center

Tinnitus Functional Index

Categories: Form
Tinnitus Handicap Inventory (THI)-ReSound
Premier Hearing Center

Tinnitus Handicap Inventory

Categories: Form
Tinnitus Reaction Questionnaire (TRQ)
Premier Hearing Center

Tinnitus Reaction Questionnaire

Categories: Form
Patient Forms Prior to Visit
Premier Hearing Center

For greater efficiency Please view and Print Forms prior to your appointment! Patient Intake Form Notice of Privacy Practice Acknowledgement Assignment of Benefits Notice of Privacy

Categories: Form
PATIENT QUESTIONNAIRE – Premier Hearing Center
Premier Hearing Center

PATIENT QUESTIONNAIRE 

Categories: Form
PATIENT DEMOGRAPHIC FORM – Premier Hearing Center
Premier Hearing Center

PATIENT DEMOGRAPHIC FORM

Categories: Form