Patient Forms

In order to maximize the time we get to spend with you during an appointment, we have provided our forms online. Please follow the links below to print and fill out each form before your first appointment with us. If you have any questions, please feel free to call us at (502) 632-1460 or email us at

Case History


Financial Agreement

Medication List

Notice of Privacy Practices

Release of Information


Office: (502) 632-1460

Fax: (502) 632-1458

2226 Holiday Manor Center #4
Louisville, KY 40222

KY Hearing Clinic