Follow the steps to efficiently complete the form online.

1. Press the 'Get Form' button to access the Audiology Case History form and open it in your preferred editor.
2. Begin by entering your full name in the 'Patient Name' field to identify your case.
3. In the 'What concerns are you here for today?' section, select the issues you are experiencing such as hearing loss, ear noises, dizziness, or other concerns. If you select 'Other', provide specific details in the designated area.
4. Indicate your age in the respective field to help the audiologist understand demographic factors.
5. On a scale of 1 to 10, circle the number that best represents your hearing ability, with 1 being poor and 10 being excellent.
6. Answer whether you have been diagnosed with hearing loss by selecting 'Yes' or 'No'. If yes, indicate which ear is affected and detail how long you have been aware of the hearing loss.
7. Complete the question about whether you have worn hearing aids. If yes, indicate how long you have worn them and specify if you wear one or two hearing aids.
8. Answer whether one ear hears better than the other by choosing the appropriate option for right or left.
9. Describe the onset of your hearing loss as either gradual or sudden.
10. Indicate whether any family members have a history of hearing loss and provide their relationship to you.
11. For any past ear surgeries, describe the reasons and timeframes.
12. Respond to the questions regarding tinnitus, ear pain, ear drainage, ear wax build-up, and dizziness, answering with 'Yes' or 'No' and providing additional details where requested.
13. Address exposure to loud noises in your life. If applicable, specify any hearing protection used.
14. Complete the allergy questions and any other health-related inquiries, including medications you are currently taking.
15. Finally, indicate who referred you to Advanced Audiology, LLC, and review your responses for accuracy.
16. Sign and date the form to authorize Advanced Audiology, LLC to process your information.

Complete your Audiology Case History online today to take the first step toward better hearing health.