Forms

Southwest Ohio ENT Specialists Patient Information Form
This form is required for all new patients and is updated yearly.

Privacy Practices Acknowledgement Form
This form is required for all new patients and is updated yearly.

Notice of Privacy Practices (HIPAA)
There is nothing to complete on this form, it is only the Privacy Practices policy for your records.

Hillcrest Hearing Aids & Balance Center - Audiological Case History
This form is to be completed by new Hillcrest patients.

Hillcrest Hearing Aids & Balance Center – Special Testing Information Sheet

• Hillcrest Hearing Aids & Balance Center – VNG or ENG Testing Instructions
  This is the form of special instructions for those patients scheduled for a VNG or ENG test. There is nothing to complete on this form but information should be read and instructions followed for this test.
• Hillcrest Hearing Aids & Balance Center – Dizziness/Vertigo Questionnaire
  This form is to be completed by any patient having one of the special tests procedures listed on our website under the Balance Center section.