Please download the following three (3) forms before your first Tinnitus Evaluation office visit to the Ear Institute of Chicago.
Please complete the Tinnitus History Questionnaire and the Tinnitus Reaction Questionnaire prior to your visit.
To download the PDF forms, you must have Adobe Acrobat Reader (on a PC) or Preview or Adobe Acrobat Reader (on a Mac) computer. If you do not have Adobe Acrobat Reader, you may download a FREE copy of Adobe Acrobat Reader here.
1. Tinnitus Visit Instruction Sheet
2. Tinnitus History Questionnaire (This form is editable. You may type into the appropriate form fields on your computer (Mac or PC)).
3. Tinnitus Reaction Questionnaire (pdf) or complete the Tinnitus Reaction Questionnaire online by clicking here.