Audiology Client History Forms
Intake Forms
Below are the forms necessary for new patients to be seen at WWU's Hearing Clinic. If you have questions about which forms to complete, or how best to complete them please reach out to our front desk at (360) 650-3881.
Once the forms are completed, please attach forms and send back in an email to SLHclinic@wwu.edu
If you print the forms, please mail to
Speech-Language and Hearing Clinics
516 High Street
AIC 256, MS 9171
Bellingham, WA 98225
Audiology Intake Forms - English
Adult Client Intake Form
- Fillable PDF
- Print Word
Pediatric Client Intake Form (17 years and younger)
- Fillable PDF
- Print Word
Clinic Consents and Policies Form
- Fillable PDF
- Print Word
Cochlear Implant Addendum
- Fillable PDF
- Print Word
Dizziness Addendum
- Fillable PDF
- Print Word
Tinnitus Addendum
- Fillable PDF
- Print Word
Formularios de admisión de audiología
Formulario de Informacíon del Paciente
- Imprimir
Clínica de Audiología: Formulario de Historial Médico para
Adultos
- Imprimir
Clínica de Audiología:
Formulario de Historial Médico para Bedés y Niños
- Imprimir
Formulario de consentimientos y políticas de la clínica
- Imprimir Word