Patient Forms
Please complete the appropriate questionnaire(s) before your appointment. These tools help Dr. Harrison better understand your experience and tailor your evaluation and treatment plan.
Select a Questionnaire
Click on any form below to open it directly on this page. You can complete and submit it without leaving the site.
How to Prepare for Your Appointment
A little prep makes your visit faster and more useful. Bring what you have; don't stress about what you don't.
Prior Hearing Test Records
If you've had a hearing evaluation before, request a copy and bring it along. Or have the clinic fax it to us. Copies help us move quickly to treatment instead of repeating tests.
Medications and Supplements
Bring a list of everything you take, with dosages and start dates. Many medications can influence tinnitus perception. Details matter here.
Intake Forms
Complete the intake paperwork sent by email. If that's not handy, arrive 15 minutes early to finish the forms and questionnaires in the office.
Bring a Loved One
A second set of ears helps — especially when discussing options and next steps. They can also share what they notice about your hearing and sleep.
Your Tinnitus Snapshot
Jot a few notes: what it sounds like (ringing, hissing, whooshing), which ear(s), when it's louder, what helps (fan, sound app), how it affects sleep, and a simple 0–10 annoyance rating. Two minutes of notes gives us a head start.
Hearing and Tech You Already Use
If you own hearing aids, earbuds, sound machines, or TV streamers, bring them (and chargers). We can check settings, show tinnitus features, and streamline what you already have.
Insurance and ID
Please have your ID ready. We do not accept any insurance. Payment is expected in full at the time of the visit.
Your Top Questions
Write down the three things you absolutely want answered. We'll hit them before you leave.
Optional: One-Week Log
A short, 7-day note of when tinnitus flares, what you were doing, sleep quality, and stress level can reveal easy wins for your plan.
Bring someone if you'd like. A spouse or friend can help you remember details and give another perspective on sleep, TV volume, and daily challenges. Many patients find that helpful.
What to Expect at Your Tinnitus Evaluation
This visit is about you — your sound, your history, your goals. We look for causes we can treat, and we build a plan you can live with: simple, clear, step by step.
Check-in and quick prep
We confirm paperwork, scan insurance, and make sure we have prior test results if you brought them. If you didn't, no problem — we'll still move forward and fill gaps later.
Conversation and questionnaires
You'll sit down with a Doctor of Audiology (CH-TM). We talk through what you hear — ringing, hissing, whooshing, pulsing — and when it shows up. We use brief tools, such as the THI/TFI, to measure impact. These scores help us track progress over time, not just "how it felt today."
Medical and sound history
We review noise exposure, ear/sinus issues, headaches or TMJ, sleep, stress, and medications. Small details matter. A change in a prescription, a new workout class, a recent cold — any of these can nudge tinnitus.
Complete hearing evaluation
We test hearing across pitches and volumes to see what's missing and where. If hearing loss is present, we explain how it relates to your tinnitus. Clear hearing reduces listening effort. Less effort often means less awareness of tinnitus.
Tinnitus measures (when appropriate)
We may match pitch and loudness, find your minimum masking level, and check residual inhibition. That tells us how your brain responds to sound and which therapies are most likely to help. Two patients can report the same "ringing," yet need different tools. These measures sort that out.
Results in plain English
No jargon dump. We translate every graph and number into what it means for your day — why it's worse at night, why restaurants wipe you out, why some days are quiet and others roar. You'll understand the "why," not just the "what."
Treatment options — prioritized, not piled on
We start with the fewest effective moves for your situation: hearing aids if hearing loss is part of the picture, Widex Zen Therapy elements, Tinnitus Retraining Therapy, LACE AI, sound enrichment for quiet rooms and bedtime, and counseling partners when stress and sleep need support. We'll explain why each option is in (or out) for you right now.
Hands-on demos when useful
You can see and handle devices, hear sample programs, and review how apps work. If you already own hearing aids or accessories, bring them. We'll show tinnitus features you might not be using yet.
Red-flag screening and referrals
If we see signs that need a medical work-up — sudden hearing loss, pulsatile (heartbeat) tinnitus, one-sided tinnitus, severe vertigo — we coordinate quickly with the ENT. You won't be left to figure it out alone.
Your written plan
You leave with clear next steps: what to start, how often to use it, and when we'll check in. We include practical sleep ideas, volume/streaming tips, and a simple way to note flare-ups. Nothing vague.
Follow-ups and timeline
Expect an early follow-up in 2–4 weeks to fine-tune settings and review how you're doing in the real world. Habituation builds over weeks to months, which is normal. We'll recheck THI/TFI so improvement isn't just a feeling — it's measured.
Costs and coverage — straight talk
We outline costs up front and explain what's included. No push. No mystery fees. You decide at your own pace.
That's the visit: a clear explanation, a focused plan, and support that continues after day one.
Questions About the Forms?
If you are unsure which form to complete, or if you have difficulty with any of the questionnaires, please contact our office before your appointment. We are happy to assist.
Ready to schedule your evaluation?
Call our office to book an appointment with Dr. Harrison.