{"id":4171,"date":"2020-10-15T13:06:23","date_gmt":"2020-10-15T20:06:23","guid":{"rendered":"https:\/\/upacifichearing.fm1.dev\/?page_id=4171"},"modified":"2024-04-05T09:20:23","modified_gmt":"2024-04-05T16:20:23","slug":"san-francisco-location-forms","status":"publish","type":"page","link":"https:\/\/hearingclinic.pacific.edu\/patient-forms\/san-francisco-location-forms\/","title":{"rendered":"San Francisco Location Forms"},"content":{"rendered":"\n

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.<\/p>\n\n\n\n

New Patient Forms<\/summary>
\n
New Patient Intake Form (English)<\/a>Download<\/a><\/div>\n\n\n\n
New Patient Intake Form (Spanish)<\/a>Download<\/a><\/div>\n\n\n\n
New Patient Intake Form (Chinese)<\/a>Download<\/a><\/div>\n\n\n\n
Adult Audiologic Case History<\/a>Download<\/a><\/div>\n\n\n\n
Pediatric Audiologic Case History<\/a>Download<\/a><\/div>\n\n\n\n
Telemedicine Consent<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
Privacy Practices<\/summary>
\n
Notice of Privacy Practices<\/a>Download<\/a><\/div>\n\n\n\n
Privacy Practices Acknowledgement (English)<\/a>Download<\/a><\/div>\n\n\n\n
Privacy Practices Acknowledgement (Spanish)<\/a>Download<\/a><\/div>\n\n\n\n
Privacy Practices Acknowledgement (Chinese)<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
Vestibular Evaluation Forms<\/summary>
\n
Dizziness Handicap Inventory<\/a>Download<\/a><\/div>\n\n\n\n
Vestibular History Intake Form<\/a>Download<\/a><\/div>\n\n\n\n
Videonystagmography (VNG) Patient Pre-test Instructions<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
ABR Evaluation Form<\/summary>
\n
Natural Sleep Auditory Brainstem Response Pre-test Instructions<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
Tinnitus Evaluation Forms<\/summary>
\n
Tinnitus Intake Form<\/a>Download<\/a><\/div>\n\n\n\n
Tinnitus Handicap Inventory (THI)<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
Release of Information<\/summary>
\n
HIPAA Disclosure Authorization<\/a>Download<\/a><\/div>\n\n\n\n
HIPAA Release Request<\/a>Download<\/a><\/div>\n<\/div><\/details>\n\n\n\n
Medical Clearance for Hearing Aid Use<\/a>Download<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

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.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":233,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","event_date":"","formatted_date":"","formatted_time":"","location":"","footnotes":""},"service_tags":[],"_links":{"self":[{"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/pages\/4171"}],"collection":[{"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/comments?post=4171"}],"version-history":[{"count":0,"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/pages\/4171\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/pages\/233"}],"wp:attachment":[{"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/media?parent=4171"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/hearingclinic.pacific.edu\/wp-json\/wp\/v2\/service_tags?post=4171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}