Patient Forms
We have made our Hearing and Balance Center forms available for downloading
and printing here on our web site for your convenience. These forms are
in an Adobe PDF
format. If you don't have Adobe Acrobat Reader, you can download the
free software
using the link here.
If you've been referred to the Hearing & Balance Center for testing,
the following Patient History Form and Dizziness Handicapp Inventory
should be completed and brought to your first visit.
- Medical History Questionnaire
- Dizziness Handicap Inventory
You will also need a driver to take you back home after testing.
If you have any questions while filling out
these forms, contact the Hearing & Balance
Center at 320-214-6997.
PATIENT FORMS
1. Medical
History Questionnaire
2. Dizziness Handicap Inventory
3. Release
of Medical Records
4. Map/Directions
5. Notice of Your Privacy
Rights
DIAGNOSTIC TESTING INStRUCTIONS
7. Instructions/guidelines
for VNG testing
8. Instructions/guidelines for Computerized Dynamic
Posturography (CDP)
9. The Activities-specific Balance Confidence (ABC)
Scale
10. Settling Techniques
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