Client Forms

All forms are PDF downloads which requires Adobe Reader. If you do not have the Free Adobe Reader Plugin, please download it from this link. Should you have any difficulty accessing or submitting the forms, please don’t hesitate to call us at (718) 990-6480 

Please complete the following forms and return to us at your earliest convenience.

• Intake Form (PDF) or    Intake Form with Online Submission
• Notice of Privacy Acknowledgement Form

In preparation for the examination, we would like you to provide us with important information. This information will assist the clinic staff in planning for and conducting a complete examination. Please choose from the list of underlined links below. 

Please bring these forms when you arrive for the appointment or preferably mail/ fax prior to your appointment.

 For a PDF document file list of general directions to our Speech and Hearing Center click here

For point by  point turn directions and public transportation information via our Google Maps place page  click here