{"id":204,"date":"2019-05-10T23:15:45","date_gmt":"2019-05-10T23:15:45","guid":{"rendered":"https:\/\/evergr19.fm1.dev\/resources\/patient-forms\/"},"modified":"2020-03-24T13:24:04","modified_gmt":"2020-03-24T20:24:04","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/everhear.com\/resources\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n

We understand that your time is valuable<\/h2>\n\n\n\n

In order to make your clinic visit more worthwhile, we\u2019ve included some useful forms that you can fill out online to prepare in advance of your appointment. Simply click on your appointment type, write your name, read the directions, and fill out all the boxes. When you are finished sign your name, date the form, and press submit.<\/p>\n\n\n\n

For the best experience, we recommend using the latest version of your preferred internet browser. If you need help viewing and filling out the forms. <\/p>\n\n\n\n

You can also download our Printable PDF Forms<\/a> if you prefer to handwrite your health history. <\/p>\n\n\n\n

Online Forms<\/h2>\n\n\n\n

Audiology Forms<\/h3>\n\n\n\n\n
<\/path><\/svg> Contact Information<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Hearing Health History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Auditory Processing Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Hearing History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Auditory Processing Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Balance Assessment Patient History and Instructions<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n<\/table>\n\n\n\n

Speech-Language Pathology Forms<\/h3>\n\n\n\n\n
<\/path><\/svg> Adult Fluency History<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Speech Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Voice History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Case History Update<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Accent Modification<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Birth to Preschool Comprehensive Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> School Age Comprehensive Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Case History Update<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n<\/table>\n\n\n\n

Telepractice Consent Forms<\/h3>\n\n\n\n\n
<\/path><\/svg> Telepractice Consent<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n<\/table>\n\n\n\n

Printable Forms<\/h2>\n\n\n\n

Audiology Forms<\/h3>\n\n\n\n\n
<\/path><\/svg> Adult Hearing Health History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Hearing Health Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Auditory Processing History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Auditory Processing History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Balance Assessment Patient History and Instructions<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n<\/table>\n\n\n\n

Speech-Language Pathology Forms<\/h3>\n\n\n\n\n
<\/path><\/svg> Adult Fluency History<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Speech Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Voice History Form<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Accent Modification<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Birth to Preschool Comprehensive Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> School Age Comprehensive Assessment<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Adult Case History Update<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n
\n<\/path><\/svg> Pediatric Case History Update<\/a><\/td>\n<\/path><\/svg><\/a><\/td>\n<\/tr>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

We understand that your time is valuable In order to make your clinic visit more worthwhile, we\u2019ve included some useful forms that you can fill out online to prepare in advance of your appointment. Simply click on your appointment type, write your name, read the directions, and fill out all the boxes. When you are…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":124,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":"","footnotes":""},"service_tags":[],"_links":{"self":[{"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/pages\/204"}],"collection":[{"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/comments?post=204"}],"version-history":[{"count":0,"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/pages\/204\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/pages\/124"}],"wp:attachment":[{"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/media?parent=204"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/everhear.com\/wp-json\/wp\/v2\/service_tags?post=204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}