Patient Forms

If you are a new patient, please complete the forms below. We ask that you arrive 10 minutes before your scheduled appointment time to complete your chart. Please bring a current photo I.D. and insurance card(s) with you to your appointment. Also, if you have any other relevant information, such as recent hearing tests, these items can be helpful to our doctors.

We do ask that you have a familiar voice accompany you if at all possible. This person can be a family member, friend, or anyone else whom you communicate with on a regular basis. A familiar voice is important to the testing and discussion which will take place during your appointment. This person allows the doctor to obtain a better understanding of the types of sounds you may or may not hear on a daily basis as well as insight into situations where they have observed you having trouble hearing. In addition, you may be getting quite a bit of information during your appointment regarding the results of your hearing test as well as the types of assistive listening devices that may work best for you and the potential cost for some of these devices. A familiar voice can also act as someone to help you remember all of this information later.

Please note that our office does have a 24-hour cancellation policy. For more information regarding this matter, refer to the billing policy in your new patient packet. If you have any questions about your appointment or regarding the enclosed information, please do not hesitate to call us at (503) 284-1906.

If your insurance requires a referral for this visit, please contact our office as soon as possible with the name of your primary care physician so that we may begin the process of obtaining a referral.

Thank you again for your interest in Pacific Audiology Clinic and we look forward to seeing you.

Forms marked child are for anyone 18 and under.

In order to download these files to your computer, you will need to right-click and choose “Save As” for each file you need.