PATIENT FORMS

After completing the appropriate forms, you may either e-mail them to: info@lyricaudiology.com or fax to: 860-631-2074.

Office Policies   

New Patient Intake Form

Adult Case History

  

Notice of Privacy Practices

Notice of Receipt

 

Pediatric Auditory Processing Evaluation

 

Permission for Treatment

 

Release of Medical Information

 

Tinnitus History Questionnaire

  

Tinnitus Functional Index

  

Tinnitus Handicap Inventory