San Francisco Location Forms Posted on October 15, 2020 by San Francisco Please download and print any of the forms required for your visit. Fill them out ahead of time and bring them to your scheduled appointment. This will help expedite the check-in process. New Patient Forms New Patient Intake Form (English)Download New Patient Intake Form (Spanish)Download New Patient Intake Form (Chinese)Download Adult Audiologic Case HistoryDownload Pediatric Audiologic Case HistoryDownload Telemedicine ConsentDownload Privacy Practices Notice of Privacy PracticesDownload Privacy Practices Acknowledgement (English)Download Privacy Practices Acknowledgement (Spanish)Download Privacy Practices Acknowledgement (Chinese)Download Vestibular Evaluation Forms Dizziness Handicap InventoryDownload Vestibular History Intake FormDownload Videonystagmography (VNG) Patient Pre-test InstructionsDownload ABR Evaluation Form Natural Sleep Auditory Brainstem Response Pre-test InstructionsDownload Tinnitus Evaluation Forms Tinnitus Intake FormDownload Tinnitus Handicap Inventory (THI)Download Release of Information HIPAA Disclosure AuthorizationDownload HIPAA Release RequestDownload Medical Clearance for Hearing Aid UseDownload